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A Revolutionary Approach to Heart Valve Replacement

Linnia Victorine of Gainesville is an independent person, still living by herself at age 88. Last winter, though, she was feeling lightheaded, dizzy and increasingly short of breath. “I had a heart valve problem and was told I only had about nine months to live. Then, my doctor called to say there was a new procedure being done at Virginia Hospital Center that could help me,” Linnia says.

Linnia had severe calcific aortic stenosis, meaning that the opening of her aortic valve had narrowed significantly, restricting blood flow to her body and requiring her heart to work much harder. There are no medications to treat aortic stenosis and lifestyle changes can’t fix it. The only treatment is to replace the valve surgically. Life expectancy without surgery is less than two years.

For the past 30 to 40 years, valve replacement for aortic stenosis has required open heart surgery, including a large incision and division of the sternum to access the heart. “It’s a relatively low-risk surgery in the hands of excellent cardiovascular surgeons like John R. Garrett, MD, FACS and John Rhee, MD, FACS. However, as patients age and develop other medical conditions, the risk of surgery increases. In the past, we had no treatment for patients like Linnia who could not tolerate open heart surgery, but now we do—with Transcatheter Aortic Valve Replacement (TAVR) surgery,” says John Golden, MD, FACC, interventional cardiologist and Chief of Cardiology, Kaiser Permanente.

TAVR is a minimally invasive, catheter-based procedure that replaces the aortic valve without removing the old, damaged valve. From the groin, a catheter is threaded into the femoral artery to the aorta, which leads to the heart. A fully collapsible replacement valve is delivered to the valve site through the catheter. Once in position, the valve is unfurled and begins working immediately. Afterward, patients’ symptoms disappear, and they have more energy. Within four to six hours following surgery, they are up and walking.

With the help of experienced cardiovascular anesthesiologists, the program has embraced a unique anesthesia approach that makes the procedure even less invasive.“At Virginia Hospital Center, we perform TAVR under moderate sedation rather than general anesthesia. This is the least invasive and safest way to do it. Patients recover faster and typically stay only about two to three days in the hospital,” says Dr. Rhee.

The cardiac team from Virginia Hospital Center and Kaiser Permanente collaborated to create a TAVR program that is patient-centered and efficient. Ameya Kulkarni, MD, interventional cardiologist, Kaiser Permanente, and Co-Director of the Louise Sands Olmstead Cardiac Catheterization Lab at Virginia Hospital Center, says, “When you are already very sick, waiting for treatment or a procedure can be very debilitating. Virginia Hospital Center uses a team approach that enables us to expedite the preoperative workup much more quickly than other programs. From the time the patient is identified as appropriate for TAVR to the time the valve is implanted can be as little as one week.”

The TAVR team involves 12-15 clinicians in the patient’s care, including cardiovascular surgeons, interventional cardiologists, cardiac anesthesiologists, radiologists, perfusionists, cardiovascular operating room and cardiac catheterization nurses, registered cardiac technicians and valve coordinators. Through the entire process—from prescreening to surgery and beyond—the valve coordinator guides the patient and is available to answer any questions at any time.

“When I woke up after surgery, I could breathe easily and my head wasn’t spinning. Within a few hours, I was walking the halls of the Hospital,” recalls Linnia. Now, she is back at home and doing well.

TAVR Does Not Require Open Heart Surgery

  1. A long hollow tube (sheath) is guided into the femoral artery in the groin. Using special imaging equipment, a catheter with a ballon on the tip is threaded through the sheath and into the heart.
  2. A collapsible replacement valve is delivered to the valve site through the catheter. Once in position, it is unfurled and begins working.
  3. The tissue value is held in place by a metal frame and is designed to work like your own heart valve.

Images Courtesy of Medtronic.

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“With the addition of TAVR, we are bringing new hope to patients for whom there was no available treatment.”
John R. Garrett, MD, FACS Chief, Cardiac, Vascular & Thoracic Surgery, Virginia Hospital Center

“It is rewarding to see how quickly our patients recover after TAVR. Their quality of life is improved and they’re living longer as a result of this procedure.”

John Rhee, MD, FACS, Cardiovascular Surgeon, Cardiac, Vascular & Thoracic Surgery, Virginia Hospital Center

"TAVR is a reflection of the tremendous advancements we’ve made in cardiology. Aortic stenosis used to be a terminal diagnosis for patients who were not candidates for open heart surgery. Now the patient is up and walking later that day and going home in another day or so. It’s remarkable."
R. Preston Perrin, MD, FACC, FSCAI, Interventional Cardiologist, VHC Physician Group - Cardiology, Co-Director of the Louise Sands Olmstead Cardiac Catheterization Lab.

"It’s very gratifying to see how well patients do after TAVR. Before, they are listless, pale and tired all the time. Afterwards, the family sees the color return to the patient’s face right away. It’s a big difference. They get their loved one back."
Ameya Kulkarni, MD, Interventional Cardiologist, Kaiser Permanente, Co-Director of the Louise Sands Olmstead Cardiac Catheterization Lab at Virginia Hospital Center.

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