The procedure, transcatheter aortic valve replacement (TAVR), is designed for high-risk patients living with severe chest pain, congestive heart failure (including shortness of breath, fatigue, and edema) and other symptoms of aortic stenosis — an age-related heart disease developed when calcium deposits cause the aortic valve to narrow, forcing the heart to work harder to pump enough blood through the smaller opening.
“TAVR is definitely a game changer,” said Deepak Vivek, MD, interventional cardiologist and director, Orlando Health Heart Institute Heart Valve Center. “These patients previously would have no hope for improvement. They would eventually succumb to their disease and their symptoms would not get better. There are really no medications available that would perform a long lasting benefit. By offering our patients TAVR it significantly improves their symptoms and prolongs their life expectancy.”
Irving DeKoff, the Orlando area Institute’s first patient to have the TAVR procedure, shares his story:
Prior to TAVR, patients would have little chance for relief from medical symptoms and improvement of quality of life.
“The hope is that we can give patients a valve that will function – making the heart’s workload be dramatically relieved so they can breathe better, stay out of the hospital and spend more time with their family, and with a rehabilitative effort regain some mobility and independence.” said Mark Sand, MD, cardiothoracic surgeon and chief of staff, Orlando Health.
The artificial valve, called the Sapien THV and manufactured by Edwards Lifesciences, is made of cow heart tissue and a polyethylene skirt and is supported with a stainless steel mesh frame. The medical team takes a new route to the narrowed heart valve by going through a leg artery instead of a chest incision with traditional open heart surgery.
“To put it in its simplest terms, it is a valve on a stick” said Jeffrey Bott, MD, cardiothoracic surgeon and chair, Thoracic Surgery at Orlando Regional Medical Center. “We are able to get access to a patient’s bloodstream through their groin and slide a new valve that is on the end of a catheter up into the aortic valve area. Before we deploy the new valve we use a balloon to expand the area. Once we deploy the new valve it is functional instantaneously.”
The new approach combines the expertise of various specialists, comprised of nearly 40 clinicians for each procedure.
“Collaboration on this program is essential and requires a multidisciplinary team,” said Barry Weinstock, interventional cardiologist, at the Orlando Health Heart Institute. “While the procedure sounds very simple it is actually relatively complex and requires a lot of people’s collaboration both in accessing the patients before ever starting the procedure and during the actual procedure itself.”