UH Case Medical Center cardiologists perform TAVR procedure under twilight

Feb 19 2014

University Hospitals Case Medical Center cardiologists Marco Costa, MD, and Dan Simon, MD, are among the first in the country to perform transaortic valve replacements (TAVR) while the patient is in a "twilight" sedation, awake and communicating with them during the procedure.

What was previously major, open-heart surgery is now being done percutaneously in the cath lab with excellent results that include less recovery time and improved infection rates. On average, patients receiving the new technique are returning home within 24 hours, dramatically reducing hospital stay duration and overall associated medical costs usually incurred during a lengthy admission.

Additionally, without the need for anesthesia, post-surgical medications to counterbalance the effects of surgery are all but eliminated.

TAVR, also known as transcatheter aortic valve implantation (TAVI), is a minimally invasive surgical procedure that repairs the valve without removing the old, damaged valve. Instead, it wedges a replacement valve into the aortic valve's place. Somewhat similar to a stent placed in an artery, the TAVR approach delivers a fully collapsible replacement valve to the valve site through a catheter. Once the new valve is expanded, it pushes the old valve leaflets out of the way and the tissue in the replacement valve takes over the job of regulating blood flow.

"The TAVR procedure's success has already been proven," said Dr. Costa, Director, Interventional Cardiovascular Center at the Harrington Heart & Vascular Institute at UH Case Medical Center and Professor of Medicine at Case Western Reserve University School of Medicine. "Given the current healthcare landscape of unknown costs and insurance, as doctors we needed to evolve and provide patients with an option that doesn't involve lengthy time in a hospital bed. This allows us to solve many problems at one time."

The new procedure is FDA approved for patients with symptomatic aortic stenosis (valve narrowing) who are considered high- risk for standard valve replacement surgery. The differences in the two procedures are significant.

Usually valve replacement requires an open heart procedure with a "sternotomy", in which the chest is surgically separated (open) for the procedure. The TAVR procedures can be done through very small openings that leave all the chest bones in place or via a catheter in the femoral (leg) artery, so recovery is generally much faster with infection rates also improved.

Predominately, the best candidates for the procedure are those in their 70s or 80s and often have other medical conditions that make them a better candidate for this type of surgery. 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.