John Smeda, Transcatheter Aorta Valve Replacement (TAVR)

After new cardiac procedure, John has the heart to farm again

John Smeda is proud of the fact that he was No.1. He is also proud that his No. 1 ranking has enabled him to again tend his rhubarb patch. 

The hardworking, 83-year-old former teacher, painter and farmer who retired from farming only last year is 
the first Borgess Medical Center patient to undergo a transcatheter aortic valve replacement (TAVR).

John admits that his No. 1 status was a matter of timing. His procedure, performed by Vishal Gupta, MD, Borgess Cardiology Group, Borgess Heart Institute, was on the morning of May 13. A few hours later, another of Dr. Gupta’s patients became No. 2. 

A number of patients have received this new treatment at the Borgess Heart Institute. It is a team effort under the medical team guidance of Dr. Gupta and fellow Borgess cardiologist Frank Saltiel, MD, Borgess Heart Center for Excellence, Borgess Heart Institute; Borgess Heart Institute cardiothoracic surgeons David Martin, MD, and Jerry Pratt, MD; and Shawn Hall, DO, Kalamazoo Anethesiology. 

“The FDA has approved TAVR for high-risk and inoperable patients,” said Michelle Miller, MSN, ANP-BC, Valve Clinic Coordinator, Borgess Heart Institute. “The advanced cardiac procedure provides new hope for highly symptomatic aortic stenosis patients who had previously been considered inoperable or high-risk for surgery. 

“Patients must meet strict criteria to qualify for this treatment option,” Miller said. “It is most beneficial for high-risk older patients, or for those who have co-morbidities.” 

During the procedure, a catheter with a collapsible heart valve is inserted through an artery (usually in the groin) to the heart, and a tiny balloon is inflated in the middle of the aortic heart valve, squeezing it to 
the side. A replacement valve that fits the site of the native valve is put in place using the same catheter. 

“Dr. Gupta is a good doctor,” John said. “He is very precise. I've never had a physical like that before.” 

A native of The Netherlands 

And John has had several pre-surgical physicals before. A native of The Netherlands, John had quadruple bypass in 2002 and hip replacement surgery in the mid-2000s. Despite these medical needs, he and his wife, Frances, kept farming their 24-acres near Plainwell until last year. 

They still maintain a large plot of land where they grow primarily rhubarb. 

Frances, also born in The Netherlands, met John after their families had immigrated to Canada around 1950. “We met in the church in Brantford and were married on April 4, 1959,” she said. 

Wanting to continue his education–John grew up speaking Dutch, German, French and English–he enrolled in Calvin College and his family moved to Michigan. He later earned his master's degree in German and French at Western Michigan University. 

John took a teaching position at Kalamazoo Christian High School starting in 1969 and taught there for 11 years. In summers, he painted houses inside and out, and he and Frances grew large fields of strawberries.

About a year ago, Frances said, John had a scary moment when he had difficulty breathing and broke out in a heavy sweat. An exam at the doctor's office showed that his heart rate had fallen to 28.

“They did an ultrasound and decided that I needed a new valve,” John said. 

“I had the new treatment on a Monday and on Thursday morning before noon I was released. There have been no problems. The open-heart surgery was harder on my body than this was. I'm slowly getting 
better. More pep.” 

Dr. Gupta said he first examined John last year and found that his symptoms were the result of a “tight” aortic valve. 

“A second open-heart surgery is not easy, especially for a person the age of Mr. Smeda,” Dr. Gupta said. “We offered him the new procedure and he accepted.” 

Dr. Gupta had performed the TAVR in training, but said that John's “was my first one in the real world.” 

TAVR requires very precise measurements and planning before the surgery, he said. They must size the native valve opening and select a replacement valve that is neither too big nor too small. 

“If the replacement valve is too small, it may leak, and if it is too big, it could rupture the valve and the patient could die,” he said. “The planning is very painstaking and meticulous.” 

Procedure performed in state-of-the-art Borgess endovascular surgery suites 

Dr. Gupta said that during John’s surgery, which was done in the state-of-the-art Borgess endovascular surgery suites, there were seven physicians of various specialties and 11 staff professionals. 

Soon after returning home, John added a treadmill and stationary bicycle to a small room off their bedroom. He works as hard at his rehabilitation as he has worked all his life. 

“I lift weights, I ride the stationary bike and I walk 10 minutes on the treadmill several times a week,” he said. 

“Dr. Gupta's procedure was a good way to go. And I had wonderful care at Borgess.”