What is Transcatheter Aortic Valve Replacement? (Video)
Dr. Rovin: My name is Joshua Rovin. I'm one of the cardiovascular surgeons on the Morton Plant Hospital Valve Clinic Team.
Dr. Girgenti: I'm Dr. Gregory Girgenti, Cardiac Anesthesiologist on the Morton Plant Valve Clinic Team.
Dr. Rovin: The transcatheter aortic valve replacement procedure that we offer here at Morton Plant Hospital is a technique by which we are able to replace or repair the aortic stenosis using a catheter-based system, passing the catheter up through the femoral artery into the aorta. We're able to perform a balloon valvuloplasty to break open the aortic valve and then pass a stent with a valve on it into the valve, blow a balloon up, and implant the stent with the new valve leaflets in place, and when we remove the catheter, there's a new functioning aortic valve on a stent.
Dr. Girgenti: As the cardiac anesthesiologist during the procedure, my role is very much like the role of a conductor during a symphony to keep all of the physicians in the room operating in unison. We have very strict communication protocols. We maintain very tight blood pressure controls, which require the coordination of everyone on the team, and as a Board Certified perioperative echocardiographer, I take a very close look at the valve after the deployment to make sure that it's functioning correctly and that all of our interventions have been successful.
Dr. Rovin: Prior to transcatheter aortic valve replacement therapy, the patients needed to undergo traditional open heart surgery to have their aortic valve replaced. For some group of patients this was too much of an operation for them to be able to tolerate. They were considered to be inoperable. Those patients really had one other option, which was just medical therapy, which we know is not a very good option for these patients.
As a result, the ability to now provide transcatheter aortic valve replacement therapy for patients really gives them the opportunity to get their life back and be able to become much more functional. Oftentimes these patients are very, very sick, and if they're a candidate for transcatheter valve replacement therapy, we are able to instill a better quality of life so they can enjoy time with their family.
In determining if a patient is a candidate for transcatheter aortic valve replacement, they need to be seen in the Valve Clinic. If after evaluation by the Valve Clinic Team we feel they're a candidate for transcatheter aortic valve replacement therapy, then we're able to take them to surgery.
Dr. Girgenti: The TAVR procedure takes place in the hybrid operating room that we have here at the Morton Heart Hospital. It is a dedicated room with very specialized fluoroscopy equipment, dedicated anesthesia equipment, and a large enough venue for the cardiologists, the cardiac surgeons, the perfusionists, all the x-ray technicians, the echocardiographers to all have optimal room to perform this procedure that could not be accomplished without these specialized technologies.
Dr. Rovin: We've been pleasantly surprised by how rapidly our patients have been able to recover from transcatheter aortic valve replacement therapy. The first patient went home on the second day after the operation, and in fact he was caught in the Morton Plant Rehab Center working out during his first week. The staff over there called us right away to see if it was acceptable for this patient to be working out in the Rehab Center.
I do think that some of the patients who we're providing this therapy on are very, very sick, and therefore there certainly is a range and time frame for these patients to recover, but it appears to be faster than the traditional therapy.
Dr. Girgenti: Any patient who has a diagnosis of aortic stenosis and is interested in a transcatheter aortic valve replacement should contact their primary physician or their cardiologist.
Dr. Rovin: Patients and physicians have asked how easy is it to get involved and to find out if I'm a candidate or my patient is a candidate for this procedure, and we try to make it as easy as possible. Either go online to the website or call the Valve Clinic Coordinator where you'll be able to speak to them and they'll provide the appropriate referral paperwork and will get you in as fast as possible.