Tuesday, February 21, 2017
Innovation at Mountain States: Transcatheter aortic valve replacement a life-saving alternative to open heart surgery
This is the first in an ongoing series of articles about innovation at Mountain States. We’ll take a look at innovative new procedures, processes, services and technology from facilities all across the system.
JOHNSON CITY, Tenn. – Johnson City Medical Center recently started doing a relatively new procedure to help people who are suffering from severe aortic stenosis – meaning they need the aortic valve in their heart replaced – and for some patients it’s a great alternative to open heart surgery.
The process is called transcatheter aortic valve replacement (TAVR). A tiny aortic replacement valve is inserted through the groin and guided into place at the heart using a method similar to a heart catheterization. Thus the patient’s chest doesn’t have to be cut open for the surgery, which means a much easier recovery.
Open heart surgery is still the primary solution for aortic stenosis, but there are some people who, for various reasons, either can’t tolerate open heart surgery or are considered at risk to have it. For them, TAVR is now a viable option.
“It’s pretty amazing technology,” said Janey Owens, nurse practitioner, coordinator for the Heart Valve Clinic at Johnson City Medical Center. “Recovery time is much quicker than with open-heart surgery and is much easier on the patient. There are some risks, and not everyone is a candidate for TAVR. But for people with aortic stenosis who wouldn’t do well with open heart surgery or wouldn’t survive it, this is a way to replace their valve and to prolong their lives and increase their quality of life.
“So it’s been a real blessing to people that we can offer this.”
Owens said the Heart Valve Clinic has done six procedures so far and all patients are doing well.
WHAT’S AORTIC STENOSIS?
The aortic valve is the valve through which blood leaves the heart. Aortic stenosis occurs when the valve opening narrows and restricts the blood flow, making the heart work harder to push the blood through. Symptoms can include chest pain, shortness of breath, fatigue, dizziness or difficulty exercising. It’s a serious disease because it is progressive. Early detection is crucial because once people start having symptoms, if the aorta isn’t replaced, they will usually die within a year or two.
High blood pressure, high cholesterol and smoking can be factors associated with aortic valve disease, but it can also be caused by other factors, particularly by age and the natural calcification of the valve.
TAVR vs. OPEN HEART SURGERY
Recovery time for open heart surgery requires four to seven days in the hospital followed by a very gradual recovery that may take up to six weeks before feeling better, and six months to feel the full benefits of the surgery. TAVR, meanwhile, requires three to five days in the hospital and people generally can get back to normal activities within a few weeks.
The big question many people ask is, if TAVR is less invasive, why can’t all aortic stenosis patients have it rather than undergoing open heart surgery?
That’s because TAVR is still new and there’s no long-term research on it. Until TAVR has been proven in studies to have good long-term durability and long-term outcomes, it cannot be recommended routinely for lower risk patients with aortic valve disease.
One of the advantages of open-heart surgery is that the surgeon can actually see the valve while doing the operation. Obviously that’s not the case with TAVR, so numerous diagnostic tests are done in advance to allow the surgeons to visualize the valve and determine the specific size and placement.
The replacement valve itself is a fascinating piece of technology. The Valve Clinic uses the Edwards SAPIEN 3 transcatheter heart valve, which has a metal frame, a fabric skirt on the bottom and uses tissue made from cow heart tissue.
VALVE CLINIC AND TAVR
Physicians from the top local cardiac specialty groups (ETSU Cardiology, Karing Hearts Cardiology, Mountain States Medical Group, and Mountain States Medical Group CVT Surgery Group) joined together to create the Heart Valve Center at Johnson City Medical Center. The clinic opened in April 2016 and, after extensive training, began doing TAVR in October.
The procedure itself was developed overseas in 2005 and approved for the U.S. in 2011. It was initially recommended only for those at high risk for open heart surgery, but new studies enabled the FDA (U.S. Food & Drug Administration) to open it up to people considered at moderate risk a few months ago.
So far, patients have seen fast and substantial improvement, just as they would after successful open-heart surgery.
“There are patients who get tired easily and short of breath, or some who can’t even walk to the mailbox anymore because things have gotten so bad,” Owens said. “So it’s a great joy to be able to give them back some of their life so they can get out again, go to church, go to the store, and have some quality of life again.”
TAVR TAKES A TEAM APPROACH
Both an interventional cardiologist and a cardiothoracic surgeon work together to perform the procedure, but it involves a lot more people than that.
“Actually it’s a massive group of people from across different departments,” Owens said. “It truly does take a village. There are probably 50 or 60 people involved, from pre-procedure through post-op, but everybody involved is integral. Everybody works together for one common goal and the group is 100-percent focused. It has really promoted communication among everybody because it requires that. I’ve been in awe of everyone coming together and how hard they have worked, from administration on down.”
For more information on TAVR or the Heart Valve Clinic, click here or call 844-41-VALVE (844-418-2583)