TAVR for Aortic Stenosis Treatment

Aortic stenosis is a blockage of the aortic valve. The aortic valve is the one-way valve that leads from the heart to the aorta, which is the main blood vessel that goes to the rest of the body. It usually is what’s called a trileaflet valve, meaning that it has three parts. And what happens frequently with time is that becomes narrowed. And as it becomes narrowed, it also becomes calcified and very thickened. Once it gets to the point where the opening from the heart into the aorta becomes extremely narrowed, it actually puts a lot of strain on the heart and causes heart failure. The patients that we actually see most often for surgery have severe aortic valve stenosis and most of them have a very limited life expectancy. Some of the studies have shown that at one year somewhere between 45% and 50% of the patients die in that time period. Aortic stenosis has traditionally been treated for quite a long time with surgical replacement of the aortic valve. And the main difficulty with that in the past was is that some patients weren’t good candidates to have that kind of open-heart surgery. Currently there’s additional treatment with being able to be treated with transcatheter valves, which allows many patients, who are very poor candidates for open-heart surgery to actually have the procedure at a very reasonable risk. Doing the procedure actually involves accessing the artery and vein on both sides of the groin areas. The valve, when it goes in, is actually crimped into a catheter so that it’s a very small size, you know, in the neighborhood of 4 to 5 millimeters. And then that valve follows a wire that has previously been placed into the heart and is actually expanded into the patient’s native aortic valve. There’s two types of valves. One type of valve self-expands. And the other type of valve is balloon expandable. When the valve is positioned, the heart is actually sped up with a pacemaker, so that it has very limited output, which allows you to very accurately place these valves. And when the valve expands, it works actually almost immediately. It’s a functional valve that the patient relies on. Because of that, you don’t actually have to be on any kind of support. In an ordinary case, the patient’s own blood pressure is maintained, except for just the very short period of time when the valve is deployed. It’s actually quite remarkable how well the patients do following the procedure. So usually within an hour to an hour and a half, patients are awake and talking. And that same day they’re almost always out of bed and even walking about the floor of the unit where they are. Nowadays a lot of our patients go home even one or two days following surgery. And most of them have almost no complaints. They have a couple of little poke holes in the groin, where the catheters went in, otherwise they feel better. They’re breathing better and don’t really have any substantial pain or problems. So one of the things when this program was developed that we found here is that we actually got the expertise of many disciplines. So we have...we actually have a team of heart surgeons, interventional cardiologists, as well as radiologists and echocardiographers, which are both the technicians and the cardiologists who read those tests. By the time the patient is evaluated for one of these valves and about to undergo the procedure, they’ve had an extensive evaluation by multiple experts, as well as PAs and nursing staff and people who have all seen the patient. And we have a discussion and try to figure out the best treatment for them. I think that the patients feel that they’ve been fully evaluated. And actually most of them are pretty relieved that we’re able to offer a treatment that is short of open-heart surgery, so that they’re able to get excellent recovery from the symptoms of the disease without having to recover from the procedure, most of the time.