HEART VALVE REPLACEMENT PROCEDURE

Having TAVR available in city solves travel needs

ABIGAIL KESSLER

Sun Staff Reporter

Aminimally invasive alternative to heart surgery has come to Flagstaff for the first time through Northern Arizona Healthcare’s (NAH) Cardiovascular Institute (CVI).

The first Transcatheter Aortic Valve Replacement (TAVR) procedure in Flagstaff was performed in September by Dr David Leder and Dr Mark Tasset A team of health care experts at CVI have performed between 20 and 25 more since, putting it on track to meet the rate of larger facilities in Phoenix, said Leder, a board-certified interventional cardiologist at CVI.

While TAVR is new to Flagstaff the procedure has been commercially available for about a decade.

Leder said TAVR is currently at a point where for patients who are at moderate or low risk for open heart surgery it is considered an equal option to heart surgery and decisions on which to use often being based on the patient’s preference.

TAVR is most often used to treat a condition called aortic stenosis, where the aortic valve stiffens and narrows,becoming unable to open fully

Leder said aortic stenosis is a common condition, affecting more than two million adults older than 75 years old a total which includes“a significant number” of northern Arizona residents

Symptoms can include chest pain, fainting and congestive heart failure. For most, however, the disease will present as shortness of breath and decreased functional capacity Diagnosis starts with talking to a doctor,who can identify stenosis with a physical examination, as it often creates a distinctive heart sound (or murmur), followed by an ultrasound (known as an echocardiogram), to look at how the valves are pumping and determine the degree of severity

If aortic stenosis is left untreated for two years Leder said the mortality rate is 20% By five years,this increases to 50%, “worse than some metastatic aggressive cancers”

The “gold standard” way to treat stenosis for years had been open-heart surgery to replace the aortic valve, a method that involves cutting through the sternum, opening the chest cavity and then removing the valve and sewing in a replacement.

“Often the surgeon would describe that being akin to major trauma for your body, Leder said It s quite an insult and especially for older patients The recovery,beyond a week in the hospital,it s often months of rehab before you get back up to full strength You have restrictions: you can’t drive for six weeks can’t lift heavy things, all things that don’t exist with the TAVR procedure”

With TAVR,the new valve is instead inserted through the femoral arteries using a small incision in the leg Once it reaches the heart, a small balloon is inflated to place the new valve over the location of the existing valve (the balloon is removed after placement).

This is similar to the kind of stent that would be used to treat a heart artery blockage, Leder said, only much larger

It all allows for a faster recovery

For a typical TAVR patient, Leder said, “the recovery is two to four hours of bed rest, but you’re up in a chair that same evening and patients are walking and going home the next day Rather than a week in the hospital and months of recovery, its generally a day in the hospital and a couple days of recovery”

Before TAVR was available at the CVI, he said patients with stenosis in northern Arizona were referred to Phoenix for the procedure unless they were a candidate for open heart surgery, which is available at NAH.

“All of our patients basically had to drive to Phoenix ” he said “ To avoid the trip for them is phenomenal and also they’re getting the care by their regular providers So they’re getting the procedure by myself, who is obviously here in Flagstaff, and surgeons who are here, and they follow up with our cardiologists and primary care providers. All of them are local community as opposed to being sent elsewhere That’s been one of the most exciting things, I think, about this.”

What allowed the procedure to come to Flagstaff for the first time, Leder said, was NAH’s investment in CVI, specifically the inclusion of a hybrid operating room (OR). Staff training and other sup- port and resources was also part of this investment but the main piece was having a hybrid OR, a $7 million investment, according to NAH.

Most cardiac procedures,he explained, are done in a cardiac catherization laboratory (or cath lab), which has a different set of equipment than an operating room

While “extremely rare” (meaning, a smaller than 1% chance,Leder said),inserting the new valve as part of TAVR can tear the existing aortic valve, leading to the requirement of emergent open heart surgery to treat. Having the procedure take place in a hybrid room that has the necessary operating equipment makes it easier to respond to an emergency should one occur

Having a hybrid OR can also allow other procedures and techniques to make their way to Flagstaff, Leder said, giving examples such as vascular surgeons and new ways to treat structural heart disease. TAVR as a response to aortic stenosis is the most common example of the latter, but CVI plans to bring others to Flagstaff, such as MitraClip or valvein-valve to respond to various problems with the mitral valve.

The hope is to expand access to procedures in northern Arizona

“We have the personnel and the talent to be a true regional referral center where there really should be very little that patients should be needing to go to Phoenix for services that can’t be provided here,” Leder said. “These are all steps to that end.”

More about TAVR can be found at nahhealth.com/cardiovascular-services, or by calling the Cardiovascular Institute at 928-226-6400

“All of our patients basically had to drive to Phoenix. ...

To avoid the trip for them is phenomenal and also they’re getting the care by their regular providers. So they’re getting the procedure by myself, who is obviously here in Flagsta , and surgeons who are here, and they follow up with our cardiologists and primary care providers. All of them are local community as opposed to being sent elsewhere. That’s been one of the most exciting things, I think, about this.”