New Heart Valve Possible for More Patients with TAVR

**By Moses Mathur, MD, MSc, FACC**

HeartbeatLess than a decade ago, replacing the aortic valve required open-heart surgery and involved a long recovery.

Then in 2002, the first transcatheter aortic valve replacement (TAVR) was performed in France – a tipping point that spurred a period of intense clinical research and medical device development. The culmination of these efforts led to Food and Drug Administration (FDA) approval of the first TAVR device in the United States in 2011.

Today, select hospitals around the country with comprehensive heart care programs, like Virginia Mason, offer the catheter-based procedure for people affected by severe aortic stenosis, which happens when calcium deposits form and reduce blood flow through the aortic valve.

Treating severe aortic stenosis in Seattle

Between 2015 and 2017, Virginia Mason interventional cardiologists performed 112 TAVR cases in a specialized “hybrid” cardiac catheterization lab.

One patient who underwent the procedure last year is 90-year-old Juneau, Alaska resident Finn Larsen, who learned about TAVR from his family doctor. Knowing Larsen had long suffered from shortness of breath, his doctor told him he might be a candidate for the minimally invasive surgery given his symptoms and age.

“My choice to avoid open-heart surgery made the decision to have TAVR an easy one,” said Larsen, a father of three who has six grandchildren and two great-grandchildren. “I definitely feel better and take solace in knowing that I can soon begin cardiac rehab and resume normal activities.”

How TAVR works

Almost all TAVR procedures can be performed through catheters (small plastic tubes) placed in the arteries of the leg or hand. For a minority of cases, where leg arteries are too small for TAVR delivery, several alternative approaches exist. The most appropriate TAVR delivery approach is finalized after a discussion between the interventional cardiologist and heart surgeon, who work together.

Similar to how a stent is placed in a coronary artery, TAVR delivers a collapsed, biologic replacement valve to the aortic valve site through a catheter. The patient’s diseased aortic valve is replaced without being removed. The new valve is inserted within the old valve using X-ray and ultrasound guidance. Once delivered, the replacement valve instantly takes over the job of regulating blood flow.

Most TAVR procedures are performed under light anesthesia without a breathing tube, which helps with faster recovery. In most cases, patients are able to walk the next day and are usually discharged within one to two days of the procedure.

Risk vs. rewards

As with any procedure, TAVR is associated with some risks. Potential complications include vascular injury, post-procedure stroke, the need for a permanent pacemaker, or a leak allowing blood to flow around the TAVR valve. With improvements in device design and implantation technique, the risk of complications has diminished significantly over the last few years. These advances have enabled patients considered too frail for traditional heart surgery to receive the life-saving procedure.

Good candidates

Currently, TAVR is approved for patients with symptomatic, severe aortic stenosis, who are at intermediate or high risk for undergoing open-heart surgery. Advanced age increases risk, as does chronic illness or a condition that would complicate open-heart surgery and recovery. A care team comprised of specialists in cardiothoracic surgery, interventional cardiology, anesthesiology and echocardiography work together to determine the best candidates for TAVR.

People interested in learning if they might be candidates for TAVR should speak with their primary care provider or a cardiologist.


Moses Mathur, MD, MSc, FACC, is board certified in interventional cardiology, general Dr Moses Mathurcardiology, echocardiography and internal medicine. He practices at Virginia Mason Hospital and Seattle Medical Center. Dr. Mathur specializes in structural and interventional cardiology, transcatheter aortic valve replacement (TAVR), MitraClip, Watchman, atrial septal defect (ASD) and patent foramen ovale (PFO)

 

Advanced Procedure Makes Heart Valve Replacement Possible for More Patients

Heart_Partridge_Rantos_low_res

With his new heart valve, Bob Partridge can walk without getting winded. Trish Rantos, ARNP, measures his progress.

When Bob Partridge’s cardiologist told him it was time to treat his faulty heart valve, Bob was very aware of the problem. He couldn’t walk the 14 steps from his basement to the kitchen without stopping to catch his breath or even make it across his yard. Bob’s aortic valve had narrowed, obstructing blood flow. His heart straining to pump enough blood left him profoundly tired and weak.

Bob had severe aortic valve stenosis, a condition primarily treated by replacing the valve during open-heart surgery. Because Bob has a stoma — a permanent opening in his neck to breathe following treatment for laryngeal cancer — a chest wound from operating on his heart might become infected. Open-heart surgery was too risky for Bob, but his interventional cardiologist, Gordon Kritzer, MD, FACC, had a less invasive treatment in mind.

Bob learned he could receive his new heart valve by way of a balloon catheter inserted through a small incision in his groin. Known as transcatheter aortic valve replacement, or TAVR, a new valve is guided through an artery all the way to the heart, then expanded to replace the damaged valve. A newly constructed operating suite with the advanced imaging capability needed to perform TAVR had just opened at Virginia Mason. Bob would be the first patient to undergo the procedure there.

“I had no objection; they are great doctors,” says Bob. “I have a lot of faith in Dr. Kritzer, and Dr. Velamoor (cardiac surgeon Gautam R. Velamoor, MD, FACS) really impressed me. I said let’s do it. Somebody has to be first.”

Right after the procedure, Dr. Kritzer reported to Bob’s wife, Jacolyn, that everything had gone very well and she’d be able to see him in a few minutes. “He got such good care afterward, they were really on the case,” remembers Jacolyn. “His recuperation was so much easier than it would have been with open-heart surgery.”

Bob went home only five days after having TAVR. He wore a monitor for the first couple of weeks to track his heart rate, but didn’t feel any pain or other effects from the procedure. What he did feel was back to normal, walking and taking the stairs like he used to, without getting winded.

“My laryngectomy was a big operation, but TAVR wasn’t anything compared to that,” says Bob. “I was very willing to go along with it because I like my doctors, I know them. It was a good experience.”