Minimally Invasive Treatment Option for Aortic Stenosis
Transcatheter Aortic Valve Replacement (TAVR)
The Genesis Heart Team, which includes an experienced cardiac surgeon and cardiologist, uses the TAVR procedure as a minimally-invasive treatment option for patients diagnosed with severe aortic stenosis (AS). Genesis Medical Center, East Rusholme Street was the first in the Quad Cities to offer TAVR.
AS is a progressive disease that keeps the aortic heart valve from opening and closing properly. The heart then must work harder to push blood through the valve. Eventually it weakens, increasing the patient’s risk of heart failure. Severe, symptomatic AS often leads to debilitating symptoms, including shortness of breath, severe fatigue and rapid or irregular heartbeat, that can restrict normal day-to-day activities.
Severe symptomatic AS is life-threatening. Studies have indicated that as many as 50 percent of untreated patients will not survive more than two years.
Open Valve: The leaflets of a healthy aortic heart valve open wide to allow oxygenated blood to flow unobstructed through the valve into the aorta where it flows out to the rest of the body.
Closed Valve: The leaflets of a stenotic, or calcified aortic heart valve, are unable to open wide, obstructing blood flow from the left ventricle into the aorta. As a result, less oxygen-rich blood is pumped out to the body which may cause symptoms like severe shortness of breath.
The minimally-invasive procedure replaces a patient’s diseased native aortic valve without traditional open-heart surgery and while the heart continues to beat. This avoids the need to stop the patient’s heart and connect them to a heart-lung machine that temporarily takes over the function of the heart and the patient’s breathing during surgery (cardiopulmonary bypass).
Benefits of the minimally invasive TAVR procedure include:
- Significantly less pain than open heart surgery
- Shorter recovery time
- Life-saving option for high risk patients
The TAVR Procedure
Surgical aortic valve replacement (AVR) is an effective treatment for severe AS. During the procedure, the damaged “native” heart valve is replaced with a prosthetic valve. Open heart AVR is recommended for virtually all adult severe AS patients who do not have other serious medical conditions. For patients who are determined to be at high risk or too sick for traditional open-heart surgery, the less invasive TAVR procedure is a treatment option.
The Edwards SAPIEN XT transcatheter heart valve used for the TAVR procedure at Genesis was approved by the U.S. Food and Drug Administration in June 2014 as a therapy for patients with severe, symptomatic calcific native aortic valve stenosis. It uses bovine pericardial tissue and a fabric skirt, attached to a high strength cobalt-chromium frame.
The TAVR procedure enables the placement of this collapsible prosthetic aortic heart valve into the body via a tube-based delivery system called a catheter. The catheter can be inserted from a number of routes:
- through an incision in the femoral artery in the thigh and threaded up to the heart (transfemoral)
- through an incision between the ribs and then through a small incision in the bottom (apex) of the heart (transapical)
- through a small incision in the front of the chest and then through a small hole in the aorta (transaortic)
The TAVR Heart Team
The partnership between the cardiac surgeon and interventional cardiologist establishes the core of the TAVR Heart Team – a care team comprised of specialists from a number of disciplines that work together to facilitate optimal outcomes for each patient. This multidisciplinary approach to patient care is a critical component in TAVR, as each specialist contributes an important area of expertise that plays an integral role in the collective care process.
- The cardiac surgeon determines the most appropriate candidates for TAVR. Surgeons typically perform transapical or transoartic TAVR in a modified cardiac catheterization lab or hybrid operating room (OR) aided by imaging equipment to assist with optimal valve delivery and placement. Surgeons play a critical role in facilitating optimal outcomes in transfemoral TAVR procedures by offering their surgical expertise, as needed.
- An interventional cardiologist (IC) works closely with a cardiac surgeon in the evaluation of potential candidates for TAVR. ICs play a critical role in facilitating optimal outcomes in transapical or transaortic TAVR procedures by offering their interventional expertise, as needed.
- An anesthesiologist is responsible for ensuring safe delivery of anesthesia before and during the procedure, monitoring the patient during the procedure and overseeing post-procedure care.
- An echocardiographer uses ultrasound technology to examine and evaluate the function of the heart, including valve function and blood flow.
- The Cardiac Cath Lab and OR staff assist with device as well as room preparation, and closely monitor the patient and procedure environment both during and after the procedure.
- Intensive Care Unit, Cardiovascular Interventional Unit or Cardiovascular Stepdown Unit nursing staff provide care while the TAVR patient is hospitalized following the procedure.
- The Cardiopulmonary Rehab staff promote faster patient recovery, and return to full and productive lives, by monitoring progress in activity and exercise performance and helping manage healthy lifestyle choices.
- Advanced Registered Nurse Practitioners in the Genesis Cardiac Surgeons Clinic, have additional training in critical and cardiac care, and work in concert with physicians in preparing patients for the TAVR procedure and in providing post-procedure follow-up care.