Owensboro Health

TAVR PROCEDURE

OH doctor performing procedure that once required open-heart surgery

BY CHRISTIE NETHERTON MESSENGER-INQUIRER

As part of its efforts to place an emphasis on cardiology and heart-related procedures and treatment, Owensboro Health Regional Hospital recently began its structural heart program.

Through the program, under the direction of Dr. Ashish Rastogi, the hospital has performed 15 transcatheter aortic valve replacement (TAVR) procedures to treat patients suffering from aortic stenosis. Several more are scheduled for the coming months.

Rastogi, an interventional cardiologist with specialized training in performing TAVRs and other heart procedures, said bringing the procedure to Owensboro allows patients in need to receive the services close to home rather than traveling to another state or city.

“I was looking for a place to do these procedures in a community that would benefit from it and Owensboro seemed to be the perfect situation because they wanted to start a program,” he said. “They have a hospital that has high-end facilities and can really provide these services to the community; they just needed a physician to do it.”

Rastogi began performing TAVRs in August this year, having performed nine so far with 15 patients scheduled throughout the next month or two.

Since the program started up, he said he has received about two or three referrals per week.

TAVR, he said, is a minimally invasive procedure used to treat aortic stenosis, which is blockage of the main valve.

A TAVR replaces a narrowed aortic valve that fails to open properly — an aortic valve stenosis. In this procedure, doctors insert a catheter into the leg or chest and guide it to the heart through the old heart valve, using the natural heart valve to hold it in place.

According to Rastogi, the procedure began to become more widely used about five years ago.

Prior to that, he said aortic stenosis was treated with open-heart surgery, which is much more invasive and requires a longer recovery time.

Additionally, he said, open-heart surgery is not as ideal for patients who might have underlying medical conditions that might make them more at-risk for an invasive procedure with a difficult recovery process.

Such underlying conditions might include lung disease, COPD, individuals who have has strokes in the past, are debilitated or have multiple underlying medical conditions.

“Before 10 years ago, the only way to treat aortic stenosis was with surgery,” he said. “Now, the standard of care is to have TAVR for aortic stenosis for the majority of patients instead of having surgery.”

TAVRs, he said, are not only more minimally invasive than open-heart surgery, but have a shorter recovery time. Whereas open-heart surgery might require a week or longer of recovery in the hospital, the TAVR procedure is typically about an hour-long procedure with a day-long recovery process before the patient can be discharged.

Rastogi said aortic stenosis is actually quite common with about one-in-eight individuals ages 75 and older experiencing some level of the disease.

“It’s very common,” he said. “When it is severe, it can limit blood flow to the whole body.”

However, he said, many of these individuals who feel symptoms of the disease might not even get it checked out as the symptoms commonly get confused with regular signs of aging.

Symptoms of aortic stenosis might include fatigue, lightheadedness, dizziness, chest pain and fainting spells.

“They don’t recognize that they actually have a valve issue, so a lot of it goes unrecognized and the majority of patients actually never get seen by a doctor and get it figured out,” he said. “We know that when someone has severe aortic stenosis blockage to that degree and have symptoms of it, they don’t do very well long-term.”

About one-in-five individuals with the disease who do not receive treatment, he said, do not live past five years and 50% might pass away after two years of experiencing symptoms.

“Recognizing it and treating it is really important,” he said.

Bringing the procedure, along with other heart-focused treatments, to Owensboro, Rastogi said, creates better access for individuals to seek out care and consultation locally if they are experiencing symptoms or have concerns, rather than living with a disease that is treatable.

“Bringing this to the community here, I think, is really important because it’s a procedure … and not having to leave their community in Owensboro and having to go to Nashville or Louisville or somewhere a few hours away,” he said. being able to get this … procedure more locally and have follow up here is much better for them.”

TAVR is the latest in a series of innovations within OH’s heart program during the past year. Dr. Rastogi has also began implanting the MitraClip device, which is an alternative to open heart surgery for patients with a leaky mitral valve, and the Watchman device, which is an alternative to blood thinners for patients with atrial fibrillation. OHRH has also expanded its cardiac imaging and electrophysiology capabilities, renovated the catheterization lab and partnered with Cincinnati Children’s to provide pediatric cardiology services.

“Medicine, for me, has always been a calling, as well as a privilege.” DR. ASHISH RASTOGI

Dr. Ashish Rastogi is a board-certified interventional cardiologist specializing in the invasive and non-invasive diagnosis and treatment of complex coronary artery, peripheral vascular, valvular and structural heart diseases with minimally invasive procedures.

He attended the highly competitive accelerated Physician Scientist program at Rensselaer Polytechnic Institute and Albany Medical College. There he was inducted into the Alpha Omega Alpha honor society and graduated at the top of his class. He then completed his Internal Medicine residency at Washington University in St. Louis, followed by Cardiology fellowship at New York Presbyterian Hospital / Weill Cornell Medical Center where he was selected to be the Chief Cardiology Fellow. He pursued advanced training in Interventional Cardiology under the world-renowned Dr. Paul Teirstein at the Scripps Clinic. This fellowship included a dedicated year of training in Advanced Peripheral and Structural Heart interventions. He is currently the medical director of the Structural Heart Disease program at Owensboro Health.

— From Owensboro Health