A Life-Saving Breakthrough: How One Man Avoided a Third Open-Heart Surgery Through a Revolutionary Procedure
By the time Russell Tenofsky turned 50, he had already endured two open-heart surgeries due to congenital heart disease. But when his pulmonary valve began to deteriorate again, he faced the frightening possibility of yet another major operation — one that carried significantly higher risks.
“Every time you open the chest, more scar tissue forms,” explains Dr. Elyse Foster, Tenofsky’s cardiologist and director of Adult Congenital Heart Disease at UCSF. “That scar tissue makes each future surgery more complicated.”
A Safer Alternative to Open-Heart Surgery
Thankfully, Tenofsky’s medical team discovered a far less invasive option — a transcatheter valve replacement, a procedure that allows doctors to implant a new pulmonary valve through a vein, without opening the chest.
For Tenofsky, who was born with Tetralogy of Fallot (TOF) — a complex condition involving four heart defects — this was a potentially life-changing solution. Many TOF patients require surgery early in life, followed by lifelong monitoring and additional interventions.
His surgical journey began in 1975 at age eight. He required a second open-heart surgery in 2009 to replace his pulmonary valve after experiencing symptoms such as dizziness and shortness of breath. As Dr. Foster explains, “Replacement valves typically last around 10 years. Over time, they naturally deteriorate.”
By 2017, when Tenofsky’s symptoms returned, Dr. Foster sought a safer option. That’s when she consulted Dr. Vaikom Mahadevan, an international leader in catheter-based valve procedures.
A Medical Pioneer Steps In
Dr. Mahadevan, who joined UCSF in 2014, is among the few cardiologists worldwide to replace valves in all four positions of the heart using catheter-based techniques. He even led the world’s first catheter-based mitral valve replacement in a human patient.
“This represents a major shift in how we treat valvular heart disease,” Mahadevan explains. “For patients with multiple previous surgeries, avoiding another open-heart procedure can add up to 25 years of life.”
Fortunately, Tenofsky’s 2009 surgical valve created the perfect foundation for a valve-in-valve transcatheter procedure, allowing doctors to securely implant a new valve inside the old one.
How the Procedure Works
During the minimally invasive procedure:
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A replacement valve made from cow heart tissue is attached to a stent.
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The stent is compressed onto a balloon and guided through a vein in the groin.
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Once positioned, the balloon is inflated, expanding the stent into place.
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The new valve begins working immediately.
The entire process takes about 2–3 hours. And unlike open-heart surgery — which requires days in the hospital and months of recovery — transcatheter valve patients often return home the very next day.
Tenofsky was no exception.
“I had some soreness and bruising for a few weeks, but that was it,” he says. Doctors also replaced his cardioverter defibrillator during the same procedure as its battery was nearing end of life.
Back to Life — Stronger Than Before
Within weeks, Tenofsky was back to riding his bike trainer and enjoying the physical activities he loved.
“I had almost no restrictions and recovered fully,” he says. “It’s remarkable compared to open-heart surgery.”
He credits his long-term health to continuity of care from UCSF’s Adult Congenital Heart Disease team — experts who understand the complex needs of adults living with congenital heart defects.
“I truly owe my life to my doctors at UCSF,” Tenofsky says. Today, he volunteers with the Adult Congenital Heart Association to support others facing similar journeys.
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