Kirby Barker is no stranger to heart surgery. At the age of 56, he'd already undergone two open-heart operations to replace his aortic valves, stemming from chronic heart conditions.
But Kirby came to University of Utah Health for something he couldn't find anywhere else. At University Hospital's Cardiovascular Center, a diverse team of skilled specialists collaborate to provide an unprecedented standard of truly personalized care. For Kirby and his wife, Ruth, these specialists became known as the "Kirby Barker Heart Dream Team," performing back-to-back heart valve replacement procedures with remarkable results.
Kirby was born and raised in Idaho. He embraced the rustic, active lifestyle of hunting, fishing, and celebrating the outdoors. His love of nature turned into a full-time career in landscaping, running his own company and overseeing water and lawn maintenance, paver installation, concrete construction, and more.
"He goes full steam ahead," Ruth laughs. But in late fall 2019, Ruth noticed an uncharacteristic decline in her husband's activity. The pair initially wrote off Kirby's fatigue, chills, and trembling body to a seasonal flu. But when he couldn't stop shaking, Ruth rushed Kirby to the emergency room.
Kirby was experiencing endocarditis, an inflammation of the heart's inner linings that often occurs due to infection. Kirby's local cardiologist, Dr. Steven Writer, treated the issue with an extended course of antibiotics but also noticed deterioration in Kirby's aortic and pulmonary valves. Dr. Writer immediately referred Kirby to Dr. Anwar Tandar, an interventional cardiologist specializing in complex valve replacement procedures.
"When we see a new case, we present the data to our treatment team and discuss the best options for the patient as a group," Dr. Tandar explains. "We have a diverse breadth of expertise within the Cardiovascular Center, and I knew we'd be able to provide comprehensive treatment for Kirby."
According to Dr. Tandar, the collaborative culture fostered by the heart team is a unique asset for both patients and doctors. Each physician recognizes and appreciates their colleagues' skills, combining their expertise to brainstorm and formulate care for complex cases.
Along with Dr. Tandar, Dr. Jason Glotzbach is one of the physicians who first received data on Kirby's case. Dr. Glotzbach explains that this coordinated approach not only helps doctors diagnose and come up with treatment options—it also helps them present a more cohesive plan of care to their patients.
"It can be intimidating and overwhelming when a patient is diagnosed with heart disease or faces an operation," Dr. Glotzbach says. "Since patients are often working with multiple specialists, we try to present a united, coherent plan and streamline information flow to make it clear and concise. Our focus is on the patient experience to help them feel comfortable navigating their diagnosis and treatment options while minimizing confusion."
Doctors on the heart team levy their mutual relationships of trust during the intense and methodic steps of various procedures. For many complex heart operations, including Kirby's transcatheter aortic valve replacement (TAVR), a team of cardiovascular specialists each perform critical roles to handle catheter navigation and valve replacement.
"Here at the University Hospital, all members of the heart valve team understand each component of the procedure," Dr. Glotzbach says. "We're able to truly collaborate during the procedure. We all really enjoy working together and respect each other in and out of the operating room. It makes for a good professional environment and translates to better outcomes for our patients."
While Drs. Tandar and Glotzbach were prepared to carry out a TAVR procedure, a third specialist was needed to fully repair Kirby's heart with a transcatheter pulmonary valve replacement (TPVR). Dr. Mary Hunt Martin, a pediatric interventional specialist, was brought on board as the final member of Kirby's Heart Dream Team.
Doctors knew they would need to work together to create the most comprehensive treatment plan for Kirby, who would be traveling from out of state.
"We understood this patient was already investing a lot of time to come to our facility and that he would need multiple procedures within a short period of time," Dr. Martin says. "We wanted to get creative and make sure we could serve all his needs within a single hospital admission."
Each procedure treated parts of Kirby's heart that control blood and oxygen flow to the rest of the body. Without correction, faulty valves can cause shortness of breath and extreme fatigue; they may even be fatal. The operations restore proper blood circulation by inserting a replacement valve into the damaged valve via a catheter-based procedure. This approach was especially appealing for Kirby—going through a third open-heart surgery after infection would have put him at a higher risk for complications.
Dr. Martin explains that although TAVR and TPVR are similarly performed through minimally invasive, physician-guided catheter technology, each operation is done on a different area of the heart. In Kirby's case, the doctors needed to plan each step of both procedures to ensure each specialist had access to the proper blood vessels and arteries. Since the TAVR procedure would be done first, Dr. Tandar's team would make a special effort to keep surgical stitching away from areas Dr. Martin needed to access in order to perform the pulmonary valve replacement. Dr. Martin would also be able to check on the success of the aortic valve replacement as she accessed the heart during her operation.
As Kirby prepared to enter the hospital for his double operation, he was apprehensive about not having his wife at his side (at the time of publication, hospital visitors are limited due to COVID-19 precautions). But he knew his care was in good hands.
"Once we spoke with our doctors at University of Utah Health, I felt like I had a team helping me fight for my husband," Ruth says. "It was an amazing relief."
Ruth credits Matea Rich, Patient Coordinator at U of U Health's Cardiovascular Center, with a large part of that relief. Matea walked Ruth through each step of coordinating Kirby's care. She explained which preliminary tests could be done in Boise, set up video calls with each physician, and even found a hotel for Ruth to stay in while Kirby was in the hospital.
"It was like she was holding my hand over the phone," Ruth explains. "The communication and follow-up was just what we needed. It gave us such a good feeling about the team."
Kirby was admitted to the hospital on a Wednesday, successfully completing both operations within a 72-hour span. When he was cleared for release just one day after his second operation, the first thing he wanted to do was go for a walk.
"I was thrilled," Ruth joyfully recalls. "I thought, 'Yeah, I've got him back!' These doctors saved his life and saved our family."
Since his procedures, Kirby has experienced significant change in his abilities. He could immediately breathe better and felt his energy improve right away. In comparison to his previous operations, which used a traditional incision and open chest cavity, Kirby jokes that undergoing TAVR and TPVR was "as easy as flossing my teeth."
"A few months ago, Kirby couldn't move the way he wanted to," Ruth says. "We couldn't get outdoors, or play with our grandkids. Now, we're blowing bubbles and playing in the creek alongside them."
"Kirby is an active, engaged person," Dr. Glotzbach adds. "These procedures gave him back the ability to do things he'd missed out on for years."
Aortic and pulmonary valve replacement procedures require lifelong follow-up. As technology improves and valves wear out, additional care may be needed. But thanks to the comprehensive care received with the team at U of U Health, Kirby—and other patients like him—will be in better shape to tolerate ongoing care in the future.
"We have a special group of people that are able to focus on what's best for the patient." Dr. Martin says. "Individually, we don't have all the answers, but collectively, we pull in so much expertise and create the best solutions. We figure out the optimal way to take care of patients together."