Amazing Things: Howard DeSavino
A former firefighter's cardiologist has seen him through more than three decades of advances in care, including the groundbreaking TAVR procedure, that have saved and prolonged his life.
Thirty-five years ago, former fire captain Howard DeSavino was having what seemed like a typical morning at work in North Bergen Township, New Jersey, when he started to feel ill.
“I walked up the street to get a lottery ticket, and somebody yelled, ‘We got a job!’” recalls Howard, now 86. “I ran back, put on my coat, boots, and helmet, and headed out the door. But the truck had barely made it a block and a half before I suddenly became lightheaded and passed out.”
His colleagues pulled the truck over and called for help. Howard had to be carried to a police car, which transported him to a hospital. After a few hours of observation, he started to feel better, but he knew he wanted to be seen at NewYork-Presbyterian/Columbia University Irving Medical Center, where his older brother’s internist worked.
Once there, he was referred to a young cardiologist named Dr. Allan Schwartz, who is now chief of the division of cardiology at NewYork-Presbyterian/Columbia.
“I was terrified that he was going to tell me that I’d had a heart attack, and that my career in the fire department would be over,” Howard says.
Instead, Dr. Schwartz evaluated him and informed him that he was born with an undersized valve.
“He knew that right away, just from listening to my heart with his stethoscope,” marvels Howard.
More specifically, Howard was born with a bicuspid aortic valve, a common congenital condition in which a person has two flaps in their aortic valve instead of the usual three. The flaps, medically known as leaflets, open and close to send blood from the heart to the main artery of the body, the aorta. Symptoms don’t always present right away, but the condition often progresses as a person ages into their 40s and 50s, according to Dr. Schwartz.
“Howard had the classic symptoms indicating he had developed severe aortic valve stenosis, a narrowing of the valve opening which restricts blood flow into the aorta and through the rest of the body,” says Dr. Schwartz. The heart of those with aortic valve stenosis works harder to pump enough blood through the smaller valve opening, which can lead to chest pain, heart palpitations, fatigue, heart murmur, and possibly heart failure.
Dr. Schwartz informed Howard that he would require an aortic valve replacement, with a tissue valve made from a pig valve. In the early 1980s, this was a relatively new procedure that required full-scale open-heart surgery, says Dr. Schwartz.
Dr. Schwartz’s colleague, Dr. Frederick O. Bowman Jr., who pioneered many of the earliest cardiac repair techniques, performed the surgery to remove his damaged valve and replace it with the tissue valve.
“In those days, it was a little tricky, open-heart surgery,” says Howard. “I was scared out of my mind. I was convinced I was going to die.”
The operation was a success, and Howard spent a week in the hospital recovering. About 10 days after returning home, Howard says, he was able to walk about 3 miles at a stretch.
“Before the surgery, I’d been in pretty good shape, playing full-court basketball with my fire department,” he recalls, “but the recovery still seemed unbelievable.”
A Deepening Bond
With his new valve in place, Howard’s life returned to normal. He resumed his job at the fire department, his basketball and softball games with colleagues, and, he says, much to Dr. Schwartz’s chagrin, his regular diet of pasta and bread (he also loves ice cream, though cut back on doctor’s orders).
“He’d want me eating vegetables seven days a week,” Howard says, “but I’d just say, ‘Doc, I’m Italian!’”
In the years following his surgery, Howard saw Dr. Schwartz once or twice a year for annual checkups, and as time went on, he began to seem more like a family friend. They shared talks about life and their families, and the Knicks, who Howard recalled as being Dr. Schwartz’s favorite basketball team.
In 1999, Howard began noticing subtle symptoms of breathlessness but didn’t think too much of it, until his next checkup with Dr. Schwartz.
“The valve lasted about 17 years, and on one visit, Dr. Schwartz says, ‘Well, Howie, it’s time for another valve. This one is about worn out,’” Howard says.
“The tissue wore out and was leaking severely, causing his shortness of breath,” recalls Dr. Schwartz.
Howard was concerned, as he was up for a promotion as deputy chief of his fire department.
“I told him I was on the deputy chiefs’ list and asked if I would be OK,” says Howard. “He reassured me that I would be going back to work.”
In 2000, the best option available was still open-heart surgery, like his first operation. This surgery was performed by Dr. Craig R. Smith, now the chair of the department of surgery at NewYork-Presbyterian/Columbia.
It’s a complicated procedure, and Howard developed a minor infection, but the surgery was ultimately a success, and Howard healed nicely, according to Dr. Schwartz. His recovery in the hospital, which involved breathing exercises and walking, took about a week. Howard was soon able to take his post as second in command of his fire department.
“The ultimate job of a physician, the whole healthcare system, ideally, is to keep people out of the healthcare system as much a possible through as much prevention as possible and through treatments that are aimed at getting people back to their normal life,” says Dr. Schwartz.
The years passed and Howard’s life changed. He retired, and his beloved first wife, Linda, died of pancreatic cancer.
When Howard confided in him that he had started dating his current wife, Sara, “I’d never seen Dr. Schwartz so excited,” he recalls. “It didn’t feel like going to checkups with my physician — it felt like sitting down with my brother.”
A Third Chance at Life
One day in 2015, Howard started feeling winded and exhausted. A few days earlier, he’d noticed he was feeling short of breath while carrying a couple of beach chairs on Long Beach Island.
“You just know something’s going on,” he remembers. “You say to yourself, ‘This used to be so easy, and now it’s a little more difficult to do.’”
He told Sara to call the EMTs, who transported him to a hospital in New Jersey. Panicked, he called Dr. Schwartz, who arranged for an immediate ambulance transfer to NewYork-Presbyterian/Columbia.
The bad news was that Howard needed another valve replacement since the valve has a finite lifetime. The good news was that he was a candidate for a new, nonsurgical procedure called transcatheter aortic valve replacement (TAVR), which could replace the valve without open-heart surgery.
“It was the simplest thing I ever went through. I have had a root canal that was worse than that,” says Howard of the procedure.
To perform the TAVR procedure, an interventional cardiologist, working with a surgeon, inserts the replacement valve through an artery in the groin and advances it into the heart using a catheter. Then, the valve is expanded with a balloon and immediately functions in place of the damaged valve. NewYork-Presbyterian has performed more TAVR procedures than any other hospital in the country.
“Howard was 83 when he had his valve therapy, TAVR. Thanks to this new advance, we didn’t have to subject him to the risks of open-heart surgery, which would have been an exhaustive recovery at that age,” says Dr. Schwartz.
Howard was admitted to NewYork-Presbyterian/Columbia on a Thursday for his TAVR procedure, performed by Dr. Susheel K. Kodali, director of the Structural Heart & Valve Center at NewYork-Presbyterian/Columbia and members of the heart valve team, and was home by Sunday.
Within days, he was out and about doing his normal daily activities, and going out to restaurants with his wife.
“I literally walked out of the hospital feeling in A1 shape,” Howard says. “It was so easy.”
Thanks to his new valve, Howard has been able to remain active, going for frequent 30- to 40-minute walks with Sara, swimming, and playing tennis. And he is teaching Sara how to golf.
Ask him if he’d go back to NewYork-Presbyterian again, and Howard doesn’t hesitate.
“The care at NYP is like no other,” he says. “The nurses are great, the people are great, the physicians are great, the valve team is great,” he says, singling out Dr. Schwartz’s medical secretary, Trudi Santobello. “It’s the best in the world. Dr. Schwartz is the best cardiologist in the world. When you see him, you know that you are in the best of hands.”