By Dr. Jacob Townsend
Interventional Cardiologist at Birmingham Heart Clinic
Physicians at Birmingham Heart Clinic are now utilizing the transcatheter aortic valve replacement (TAVR) procedure at St Vincent’s East. TAVR is a less-invasive approach to aortic valve implantation for patients considered high-risk or inoperable for traditional open-heart valve surgery.
BHC cardiologists Drs. Jacob Townsend and Robert Yoe are performing the valve replacement using the Medtronic Evolut R transcatheter heart valve. A team of cardiologists and cardiovascular surgeons perform the procedure, which treats severe aortic stenosis by using a catheter-based process to implant an artificial valve.
Aortic stenosis occurs when aortic valve does not open properly, hindering the heart from pumping blood throughout the body. If left untreated, the aortic valve creates additional work for the heart, leading to heart failure and finally death. Symptoms of aortic stenosis include chest pain, fatigue, feeling faint, passing out, and shortness of breath with activity. It is diagnosed with an exam and cardiac ultrasound. Historically, surgical aortic valve replacement has been the treatment of choice, and continues to be for most patients; however, aortic stenosis is frequently not severe until patients are in their 70s and 80s, at which point their surgical risk is often higher. In fact, up to 30 percent of patients with severe aortic stenosis are not candidates for surgical therapy, and may be best served by TAVR.
The Medtronic Evolut R is a new generation of transcatheter valve, combining an increasingly small catheter with the unique ability to be recaptured and repositioned to ensure proper placement. Its size allows nearly all patients to be treated from a femoral arterial approach with a preferred access site to reduce complications and speed recovery. It is designed to replace a patient’s diseased native aortic valve without the need for open-chest surgery and without stopping the patient’s heart, making it ideal for patients who are considered high-risk for open heart surgery.
During the procedure, the bio-prosthetic valve is guided by a catheter to the heart. After the valve is in the correct position, the catheter is retracted, allowing the newly implanted valve to self-expand and take over the function of the native aortic valve.
When symptoms develop in patients with severe aortic stenosis, there is a well-plotted decline through heart failure to death. While medical therapy has not been shown to affect this course, valve replacement offers lifesaving intervention. This has been reserved in the past to those who were reasonable surgical candidates, but can now be offered in a much less invasive manner for those at higher risk. Ongoing studies are evaluating TAVR in low and intermediate risk patients, but it is clearly the preferred option for those at high-risk for surgical complications.