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Transcatheter Aortic Valve Replacement is a treatment option
alternative for intermediate to high risk patients not eligible for traditional therapies.

The heart and vascular team at ProHealth Waukesha Memorial Hospital is one of only a few in Wisconsin to offer TAVR as a treatment option. It is the first in southeastern Wisconsin to use SAPIEN 3, the latest generation heart valve, approved by the FDA in June 2014.

Transcatheter aortic valve replacement (TAVR) now makes it possible for patients with severe aortic stenosis and considered to be at intermediate or high risk to have traditional open-heart surgery to get their severely diseased aortic heart valves replaced with a minimally invasive procedure.

During TAVR, a new valve is put in place using a catheter (see figures below) inserted through a small incision in either the leg (transfemoral), between the ribs (transapical) or through the chest (transaortic). The technique prevents the need for an open-chest procedure and allows for valve replacement without stopping the patient's heart, avoiding the need for a heart-lung machine to control the patient's heart beat and breathing.  

Above shows the progression of the insertion of the new valve using the transaortic approach.

 

Core TAVR Team

A multi-disciplinary heart team approach is a critical component to achieving optimal outcomes with TAVR. The collaboration between the cardiothoracic surgeons and interventional cardiologists establishes the core of the TAVR heart team. The TAVR team also consists of echocardiographers, anesthesiologists, imaging specialists and staff from the cardiac catheterization lab. All of the care they delivered is coordinated by our valve program coordinator who assists patients and their families with scheduling appointments, obtaining medical records, answering questions about services and more. 

Core TAVR team members include:

John Kelemen, III, MD
Cardiothoracic surgeon
Mark Stout, MD
Cardiothoracic surgeon
Lisa Schmitz, DO
Interventional cardiologist

 

What is aortic stenosis and how does TAVR help treat it?

Aortic stenosis is a common health problem, affecting nearly seven percent of people older than 65. The disorder causes narrowing of the heart’s aortic valve and restricts normal blood flow to the entire body. It occurs when the aortic value does not open and close properly, generally due to calcium or mineral build-up. Common symptoms influence an individual’s ability to perform daily activities and may include fatigue, shortness of breath, lightheadedness, fainting, rapid or irregular heartbeat and chest pain.

After symptoms appear, individuals with severe aortic stenosis have only a 50 percent chance of living two years and a 20 percent chance of living five years. Medication cannot slow or reverse the progression of aortic stenosis. The only effective treatment is aortic valve replacement. But, it is estimated that a third of patients with severe stenosis are too frail to have their chests opened and hearts temporarily stopped during traditional valve replacement surgery.

TAVR is a less invasive procedure and requires only tiny incisions between the ribs, in the leg or in the front of the chest. A catheter is threaded through an artery to deliver the new valve, all while the heart continues to beat. ProHealth Heart & Vascular Care team members perform the procedure in Waukesha Memorial’s new hybrid operating room, where the heart care team has the ability to also perform open surgery, if necessary.

“One of the problems with aortic stenosis is that the patient’s valve becomes very thick and calcified, causing the narrowing,” explains Lisa Schmitz, DO, an interventional cardiologist on the ProHealth Heart & Vascular Care team. “With TAVR, we don’t take out the old valve, but insert the new one within the diseased valve. The calcification can cause some gaps, resulting in leakage of blood back into the heart. The new SAPIEN 3 valve design has features that help reduce the leakage. The new valve delivery system also is improved, which helps the valve to be placed into position more accurately.”

From a patient’s perspective, there are many advantages to TAVR and the SAPIEN 3.

“There are better outcomes, there is a lower risk of stroke and the catheter is smaller so it can be used on a wider range of patients,” Dr. Schmitz said. “And recovery is easier than with open-heart surgery because the chest doesn’t have to be opened.” In fact, the time spent in the operating room, hospital and to recover is considerably less with TAVR.

Statistics show the average age of a patient undergoing a TAVR procedure is 82. Thirty-three percent have had heart bypass surgery in the past.

The TAVR team includes interventional cardiologists, cardiothoracic surgeons, anesthesiologists, imaging specialists and cath lab and operating room staff. Dr. Schmitz works collaboratively with John Kelemen, MD and Mark Stout, MD, both cardiothoracic surgeons practicing at Waukesha Memorial as part of ProHealth Care’s partnership with Indiana University Health, to determine whether a person is a candidate for TAVR.

“The SAPIEN 3 has the best procedural outcomes so far,” says Dr. Schmitz. “I am pleased to offer TAVR as a treatment option for my patients and to allow them to have the procedure done at a local hospital that they know and trust. That makes a big difference.”

It is estimated that only two-thirds of all patients who could benefit from valve replacement undergo the procedure each year. To learn more about TAVR or ProHealth Care’s heart surgery program, call 262-928-5300. Click to view a simulated procedure.