PINEHURST – The Valve Center team at FirstHealth of the Carolinas’ Reid Heart Center achieved a significant milestone in December with the successful completion of its 50th TAVR procedure.
TAVR (Transcatheter Aortic Valve Replacement) is a minimally invasive procedure that replaces a damaged aortic valve without actually removing it. With the TAVR approach, a balloon-expandable replacement valve is delivered to the valve site through a catheter. Once the new valve is in place, it is expanded, pushing the old valve out of the way and allowing the tissue in the replacement valve to take over the job of regulating blood flow.
The FDA-approved procedure is an alternative for patients with symptomatic aortic stenosis who are considered high risk for standard (open-heart) valve replacement surgery. A team consisting of interventional cardiologist Steven J. Filby, M.D.; cardiothoracic surgeons Peter I. Ellman, M.D., and Art Edgerton, M.D.; radiologist Michael Edwards, M.D.; and anesthesiologists from Pinehurst Anesthesia Associates began performing TAVR procedures two years ago.
“In two years, we’ve had outcomes well beyond the national average,” Dr. Filby says. “That’s a fairly remarkable run.”
The FirstHealth team currently uses a “third-generation” replacement valve with a fabric cuff with improved stability that prevents or minimizes the amount of blood around the valve. The smaller size of the current valve has also made more patients eligible for the TAVR procedure and contributed to even smaller incisions and faster recovery times.
“All of our cases are now done through an opening about the diameter of a No. 2 pencil,” Dr. Filby says, “so we don’t have to expose the vessel and cut it.”
In another advance for the FirstHealth TAVR program, the 50th procedure was performed with minimal or “conscious” sedation (as would be used in a heart catheterization) that allowed the patient to breathe on her own throughout the surgery and without the assistance of a breathing tube.
“The patient was sitting up in a chair and walking shortly afterward, which is pretty tremendous,” Dr. Filby says.
As of mid-January, the FirstHealth team had performed five more TAVR procedures since the 50th procedure – most with conscious sedation.
Although relatively new, TAVR can be an effective option to improve quality of life in patients who otherwise have limited choices for repair of their aortic valve. Patients are typically in their 70s or 80s and are at high or very high risk for traditional open-heart surgery because of such diagnoses as kidney failure and pulmonary disease or due to previous open surgeries, limited mobility or frailty. However, the success of the program and the use of the third-generation valve have opened up the potential TAVR population to include patients at even lesser risk for traditional open surgery.
“TAVR is presently being investigated in intermediate-risk patients, and the results look promising,” says Dr. Filby. “Though we are optimistic about TAVR’s future role in the treatment of valvular heart disease, it is currently only indicated in patients who are at high risk or very high risk for surgical aortic valve replacement.”
Dr. Filby attributes much of the FirstHealth program’s success to the extensive evaluation each patient receives before surgery as well as to the preparedness and cohesiveness of the entire TAVR team.
“We always have a very good game plan and go in with a lot of preparedness,” he says.
For more information on FirstHealth’s Reid Heart Center and the Valve Center’s TAVR program, click here.