A revolutionary new heart treatment is offering new hope to patients considered ineligible for open heart surgery or at great risk of suffering serious surgical complications.
Known as Transcatheter Aortic Valve Replacement (TAVR), the minimally invasive procedure is now being used to treat patients suffering from severe aortic valve stenosis. One of the most common valve disease disorders, aortic stenosis typically results from aging, as calcium or scarring narrows and hardens the heart’s aortic valve. As blood flow through the valve becomes constricted, individuals may experience chest pain, shortness of breath, fainting and palpitations. For those with severe aortic stenosis, the condition can lead to congestive heart failure and even death.
In the past, the best option for treating severe aortic stenosis was open heart surgery to replace the valve itself. But for those patients deemed ineligible for surgery, the prospects were discouraging: a greatly diminished quality of life and a life expectancy of just six to 12 months.
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Two recent approvals by the U.S. Food and Drug Administration (FDA), however, have made the potentially life-saving TAVR treatment available to even more patients, offering hope for a longer, better life.
How it works
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Unlike open heart surgery – which requires the chest cavity to be opened – TAVR involves inserting a new artificial valve by making a small incision in the thigh or through the ribs. Comprised of bovine tissue and polyester around a stainless steel mesh frame, the collapsible valve is crimped onto a catheter and guided through an artery to the site of the diseased valve. The artificial valve is then expanded with a balloon and immediately begins to function in place of the patient’s own aortic valve.
A groundbreaking development
One of the most promising new developments in the treatment of cardiovascular disease, TAVR has been used to treat more then 7,000 patients since 2011, when Edwards Lifesciences first received FDA approval to use its SAPIEN® artificial valve in inoperable patients using the transfemoral (through the thigh) TAVR approach. In 2012, the FDA expanded its approval to include the transapical (through the ribs) method, and to allow its use in patients at risk of serious surgical complications.
Edwards Lifesciences hand-selected hospitals across the nation to implement its new valve using the TAVR approach. Here in Florida, 14 hospitals were selected to offer this revolutionary treatment, including Jacksonville’s St. Vincent’s Medical Center Riverside. To offer the treatment, St. Vincent’s constructed a new specialized “hybrid O-R” that combines a traditional operating room with a cardiac catheterization lab and an interventional radiology suite. At 860 square feet, the hybrid O-R is more than twice the size of a traditional operating room in order to accommodate both the state-of-the-art TAVR equipment and a larger surgical team that includes two surgeons, two interventional cardiologists, an echocardiographer, a cardiac anesthesiologist and other medical personnel. The facility is also equipped to make an immediate transition to open-heart surgery should it become medically necessary.
Who is a candidate?
Typical TAVR patients are older individuals whose medical conditions make them a better candidate for this minimally invasive procedure. Prior to receiving an artificial valve using the TAVR approach, patients undergo a thorough screening that includes an in-depth review of their cardiological history. Often, patients are referred for evaluation after they begin experiencing some of the early symptoms associated with aortic stenosis. While TAVR may not be appropriate for everyone, this new life-saving procedure presents a promising treatment for severe aortic stenosis patients whose options were once far more limited.
Samer Garas, MD, FACC, FSCAI, is a board certified interventional cardiologist at St. Vincent’s Medical Center Riverside. A graduate of the University of Missouri School of Medicine, Dr. Garas completed his medical internship and residency at Washington University School of Medicine and later completed cardiology and interventional cardiovascular fellowships at Emory University. Dr. Garas is a member of the Duval County Medical Society. He can be reached at TAVRdoc@gmail.com or 888-501-4062.
