On Oct. 8, a Moore County World War II veteran became the first person in the Sandhills area to have a lifesaving transcatheter aortic valve replacement (TAVR).
A FirstHealth TAVR team headed by Steven J. Filby, M.D., an interventional cardiologist; and Peter I. Ellman, M.D., a cardiothoracic surgeon, performed the procedure at Reid Heart Center at FirstHealth Moore Regional Hospital.
The patient, 88-year-old Samuel Richardson of Carthage, had previously been told that he was not a candidate for open-heart surgery or traditional aortic valve replacement. Following the procedure, he showed immediate improvement and was able to return to his home – where his condition continues to progress – three days later.
He is, he says, “100 percent better.”
Patients who are TAVR candidates are too high-risk for open-heart surgery or traditional aortic valve replacement and are, for all practical purposes, dying, according to Drs. Filby and Ellman.
“Once patients start to show symptoms of aortic stenosis, their life expectancy is typically on the order of two to three years,” says Dr. Filby, an interventional cardiologist. As an interventional fellow at the Cleveland Clinic, Dr. Filby was part of the PARTNER Trial, a seminal 2010 study that demonstrated TAVR’s benefits for U.S. patients.
For eligible patients, who are usually elderly and/or very sick, TAVR is the only treatment option and not just the best one.
“TAVR is one of the most important innovations we’ve seen for cardiovascular therapy in the last 10 or 20 years,” says Dr. Ellman, a cardiothoracic surgeon. “It offers people who are prohibitively risky or very high risk an alternative to fix their valve that is much less invasive and can give them a longer and better quality of life.”
Approved in 2011 by the U.S. Food and Drug Administration (FDA) for high-risk and non-operable patients, TAVR can be a lifesaving procedure for patients with severe aortic stenosis, a valvular condition affecting about 3 percent of the American population over age 65. Caused by a thickening of tissue in the aortic valve that restricts arterial blood flow from the heart to the rest of the body, the condition can cause chest pain, shortness of breath, dizziness and fatigue.
Left untreated, it is fatal.
“Although this is a new program for FirstHealth, this procedure is not new to Dr. Filby,” says John F. Krahnert Jr., M.D., FirstHealth’s chief medical officer. “He comes from one of the top TAVR sites in the U.S. and brings unrivaled experience to our program. This blends nicely with Dr. Ellman’s experience in minimally invasive aortic valve surgery for a great combination that gives our program a real advantage.”
During a TAVR procedure, the faulty aortic valve is replaced by a tiny balloon-expandable device that is inserted by catheter through a small surgical incision in the groin area of the leg or through a small incision in the chest wall at the tip of the heart.
“The balloon catheter gets inflated across a patient’s native heart valve, which gets pushed aside by a prosthetic valve that takes its place.” Dr. Filby says.
The TAVR procedure, unlike anything else in the specialty of cardiovascular medicine, requires a large team that must collaborate to deploy the stented valve successfully. Dr. Filby performed the first TAVR procedure at Reid Heart Center with the help of two cardiologists: interventional cardiologist Peter L. Duffy, M.D., who aided procedurally; and Steven Kent, M.D., who provided imaging support.
Dr. Ellman and cardiovascular surgeon Art Edgerton, M.D., helped with vascular access; and David Chandler, D.O., provided support with anesthesia.
Other members of the TAVR team include radiologist Samuel Wahl, M.D., who provides preoperative imaging interpretation; and Dona Baker, R.N., who helps to coordinate patient testing and follow-up.
Surgical perfusionists, technologists from the operating room, echo technologists and cath lab technologists are also key players on the team.