Advanced Cardiac Care Options, Close to Home
Until now, patients with severe aortic stenosis have had to give up much of what makes life enjoyable. But a procedure at Eastern Idaho Regional Medical Center (EIRMC) called transcatheter aortic valve replacement (TAVR), means they won’t have to give up hope.
EIRMC, among the first in Idaho to offer TAVR, is one of only five hospitals within 190 miles approved to perform this promising new procedure for those considered intermediate to high risk for traditional heart valve replacement, or those who were previously considered inoperable.
Patients with severe aortic stenosis, who are not candidates for open heart surgery due to age or other complications, can now be treated using a new aortic valve replacement therapy that is delivered percutaneously, done through the skin, with a catheter delivery device. The TAVR procedure has been proven to significantly improve the quality of life and survival rates for these patients.
TAVR is a minimally invasive surgical procedure that repairs a damaged valve without removing it. A team of heart surgeons and interventional cardiologists work together to place a collapsible artificial valve into the heart via a catheter. When in position, it expands and pushes the old valve leaflets out of the way, and the tissue in the replacement valve takes over the job of regulating blood flow. Before TAVR, replacing the valve was done through open heart surgery, or for some, a minimally invasive surgery through the ribs.
The procedure was approved by the FDA in 2011, but only for patients who were too high risk for open-heart surgery. The FDA approved the procedure for moderate-risk patients in 2016. Facts about EIRMC’s TAVR program:
- EIRMC TAVR program started in November of 2015.
- EIRMC uses both the Edwards Sapien 3 valve, and the Medtronic Corevalve EvolutR, depending on individual patient criteria.
- The average transfemoral (groin approach) TAVR takes about 1 ½ hours from the time patient enters the room, until lines are being removed from the groin site and patient is awakened from sedation.
- EIRMC uses moderate sedation on most transfemoral approaches instead of general anesthesia.
How it Works
A specially trained heart crew, including cath lab and OR staff, replaces the diseased aortic valve by using a balloon-expandable heart valve placed into the heart through a catheter. A catheter is a small tube, which goes into an artery through a small cut, in this case, in the groin.
- A catheter is inserted through an incision in the groin
- The catheter is carefully moved within artery to the stenotic valve
- A balloon is inflated to partially reopen the valve
- The TAVR device is implanted at the site of the narrowed aortic valve
- Blood flow through the valve is immediately improved
A New Treatment Option
We will conduct a comprehensive evaluation to determine whether this procedure is an appropriate therapeutic option for patients with severe aortic stenosis. In certain cases, TAVR may not be an option because of coexisting medical conditions or disease processes that would prevent the patient from benefitting as expected or because the risks outweigh the benefits. For those who are candidates for TAVR, this therapy may provide relief from the often debilitating symptoms associated with severe symptomatic native aortic valve stenosis.
In elderly patients, severe symptomatic aortic stenosis is often caused by the build-up of calcium (mineral deposits) on the aortic valve’s leaflets (flaps of tissue that open and close to regulate the one-way flow of blood through the aortic valve). This build-up of calcium on the leaflets impairs the aortic valve’s ability to fully open and close. As a result, the narrowed valve allows less oxygen-rich blood to flow from the lungs to the brain and rest of the body which may cause symptoms like severe shortness of breath and extreme fatigue.
Fig. 1 depicts the leaflets of a healthy aortic heart valve which open wide to allow oxygen-rich blood to flow unobstructed in one direction. The blood flows through the valve into the aorta where it then flows out to the brain and rest of the body.
Fig. 2 depicts leaflets of a stenotic or calcified aortic valve unable to open wide, obstructing blood flow from the left ventricle into the aorta.
Understanding the Risks
TAVR is a significant procedure involving either general anesthesia or moderate sedation, and placement of the valve is associated with specific contraindications as well as serious adverse effects, including risks of death, stroke, damage to the artery used for insertion of the valve, major bleeding, and other life-threatening and serious events. In addition, the longevity of the valve’s function is not yet known. For these reasons, the risks and benefits are carefully assessed by the TAVR Team and Valve Clinic physicians, and then discussed with the patient so he or she can make an informed decision about the treatment plan.
Is TAVR an Option for You?
TAVR provides another option for patients who are at intermediate to high-risk or otherwise not a good candidate for open-heart surgery. Patients are thoroughly evaluated by doctors to determine if they qualify for the TAVR procedure. Your doctor can explain your treatment options, the associated risks and help you determine which option is best for you.
Because the TAVR procedure does not require open heart surgery, there are some significant benefits for patients who qualify for the procedure, including:
- An option for patients who are inoperable or a moderate to high-risk for open chest surgery
- Reduced risk for the very ill or elderly
- Decreased risk of complications
- Smaller, less visible scar
- Reduced pain during recovery
- Faster recovery and return to normal activity
After the TAVR procedure, patients usually feel minimal to no pain, improved breathing, an overall sense of well-being – and are soon able to exercise and resume a healthier lifestyle. Most patients experience a much more rapid recovery than they would from a traditional, open-heart valve replacement.
Who is a Good Candidate?
If you have a patient with severe aortic stenosis that is not a good candidate for open-heart surgery, TAVR may be the right choice for them. Our team can help you to evaluate if your patient is a good candidate. After completing a thorough evaluation, which includes a health assessment, various heart tests and educating the patient about the procedure, we can determine if TAVR is the best choice for your patient.
At EIRMC, each TAVR patient has specialists devoted to their care to ensure the best possible outcome. We want you to be as involved as you would like to be in your patient’s TAVR procedure. We invite you to participate in your patient’s initial assessment, be present during the team conference if desired, and we will provide detailed follow-up information and instructions after the surgery is completed.