Hope can sometimes be in short supply for patients who suffer from aortic stenosis, a slow and progressive heart disorder. Transcatheter aortic valve replacement – better known as TAVR – is a minimally invasive procedure to replace the aortic valves in high-risk or inoperable patients. This procedure gives hope for a longer life, and higher quality of life, for these individuals.
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 this last summer.
The TAVR procedure expands the heart care services available locally. It is the result of ProHealth Care’s cardiothoracic surgery partnership with Indiana University Health, which has one of the nation’s top heart programs.
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.