Carolinas HealthCare System

Procedure Offers Patients a New Treatment Option

Dr. Charles Bridges
Charles R. Bridges, MD, ScD
Chair, Department of Thoracic and Cardiovascular Surgery

Dr. William E. Downey
William E. Downey, MD, FACC
Medical Director, Interventional Cardiology and Cardiac Catheterization

At Sanger Heart & Vascular Institute, our team understands the importance of staying at the forefront of innovative procedures in order to bring new treatment options to patients. Our integrated and collaborative model of healthcare demonstrates our dedication to making the best decisions for our patients while providing them with the highest quality care and outcomes.

Another Option

The interventional cardiology and cardiothoracic surgery teams at Sanger Heart & Vascular Institute were among the first in the United States selected to perform transcatheter aortic valve replacements (TAVR) for patients with severe aortic stenosis, outside of clinical trials. The FDA-approved technology offers an alternative treatment option to patients who previously were considered to be too ill to undergo open-heart surgery to replace their diseased aortic valves.

Meet Our Team

The comprehensive TAVR team includes cardiothoracic surgeons Charles R. Bridges, MD, and Eric R. Skipper, MD; interventional cardiologists William E. Downey, MD, and Michael Rinaldi, MD; and echocardiographers Geoffrey A. Rose, MD, and Markus D. Scherer, MD.

For more information about our program or to refer a patient, call our Valve Clinic Nurse Coordinator Susan McClain, RN, at 704-373-0212.

Once they develop symptoms, patients with severe aortic stenosis have a 50 percent chance of dying within one or two years unless the valve is replaced. In the PARTNER trial, patients who weren't candidates for conventional aortic valve replacement were randomly assigned to either medical therapy or TAVR. For these inoperable patients, TAVR increased the chance of surviving for one year from 30 to 50 percent. At two years, the benefit continued to increase with the absolute survival benefit rising to 24 percent. In addition, TAVR provided a major improvement in patients' symptoms, quality of life and freedom from repeat hospitalizations.

One year after randomization, 50 percent of patients treated with TAVR were alive and minimally symptomatic (NYHA class I or II) as compared with only 17 percent of patients who were treated medically.

Even though the surgery may be successfully performed, only 70 percent of the patients who receive the new valve survived beyond one year, primarily from complications that made them ineligible for surgery in the first place. In addition, the procedure remains a substantial one with associated complications including stroke and vascular injury.

A Minimally Invasive Option

In order to perform the TAVR procedure, our entire team of interventional cardiologists, cardiothoracic surgeons and echocardiographers traveled to Chicago for advanced training.

Traditional aortic valve replacement requires the patient to be put on a heart-lung machine, to stop the heart in order to replace the valve. Now, using TAVR, we're able to replace the valve by passing a catheter through the femoral artery, up through the aorta, and then implanting an artificial valve that's sewn into a stent in the area with the Procedure Offers Patients a New Treatment Option stenotic valve.

Figure 1: During transcatheter aortic valve replacement, surgeons pass a catheter through the femoral artery, up through the aorta, and then implant the artificial valve. Figure 2: The artificial valve is sewn into a stent in the area with the stenotic valve.

Benefits of the minimally invasive option include the avoidance of the need for heart-lung bypass and median sternotomy with their attendant risks. Patients generally recover faster with a nearly invisible scar hidden in the groin crease.

TAVR is a huge leap forward in the care of patients with aortic stenosis and a great advance for the field of cardiovascular medicine. As the technology evolves over time, we'll be able to treat more patients with minimally invasive options, offering better care and patient outcomes.

In the United States, about 300,000 patients experience at least moderate aortic stenosis and 50,000 receive open heart surgery to replace diseased valves. Five percent of those patients aren't candidates for open heart surgery, and until now, were unable to receive effective treatment.

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