TAVR Offers Open Heart Surgery Alternative
Patients in need of a heart valve replacement but who have comorbidities that make them poor candidates for surgery may benefit from the Transcatheter Aortic Valve Replacement (TAVR) procedure, an innovative alternative for treating severe symptomatic aortic stenosis. James Mitchell, MD, FACC; Zafir Hawa, MD, FACC, FSCAI; Alexander Pak, MD; and Keith Allen, MD are the first cardiovascular specialists in the Northland to perform this minimally invasive procedure. For a patient to qualify for TAVR, two surgeons must have declined the patient for open heart surgery.
“The mortality rate for patients who are turned down for a sternotomy is 50% at 24 months. TAVR gives them a chance at a better quality of life.” Dr. Mitchell says.
Drs. Mitchell and Hawa received TAVR training at the German Heart Center Munich (DHM), one of the highest volume centers in Europe. The Heart Team at DHM performs more than 500 TAVR procedures each year. To gain expertise, each physician performed at least 30 structural heart procedures consisting of TAVR and balloon aortic valvuloplasty.
Initially, the specialized TAVR physician team will consist of 2 interventional cardiologists from Meritas Health Cardiology, 2 cardiac surgeons from Mid America Heart & Lung Surgeons, an anesthesiologist, and full supporting clinical staff. Surgeries will be conducted in North Kansas City Hospital's new hybrid endovascular operating suite late this summer.
The TAVR procedure is done without stopping the heart. “We can use 1 of 3 approaches for accessing the damaged aortic valve: transfemoral, transapical or transaortic,” Dr. Mitchell explains. “Each requires only a small incision, which reduces the risk of significant morbidity over a sternotomy.” During the procedure, the cardiologists access the damaged aortic valve using x-ray guidance and a catheter with a balloon-expandable bioprosthetic valve affixed to the tip. “The diseased valve is heavily calcified, so we use a balloon to open it,” Dr. Hawa adds. “Then, we insert the new valve inside the old one. Radial strength holds the device in place.”
TAVR reduces a patient’s length of stay and shortens the recovery period.
“The typical hospital stay after a TAVR procedure is 2-3 nights. Patients should be mobile the same day.” Dr. Mitchell notes.
“They also are likely to avoid issues such as congestive heart failure and volume overload, which is more frequent with a sternotomy.” Periodic echocardiograms help ensure the valve’s continued viability.
Currently, TAVR is approved in the U.S. for aortic valve replacement for high risk patients. Results from an intermediate risk study in the U.S. could expand the indication to include lower risk patients.
Initially, anesthesiologists will use general anesthesia with TAVR procedures. “Eventually, it is possible we will transition to conscious sedation, which lowers patient risk even further,” says Dr. Hawa.
Ongoing Patient Support
NKCH recently established a valve clinic within its Heart Failure Clinic, which opened in late 2013. In the valve clinic, dedicated TAVR clinicians evaluate and monitor patients before and after TAVR procedures.
To learn more, call 816.221.6750.
Keith Allen, MD
Dr. Allen attended medical school at the University of Kansas School of Medicine, Kansas City and completed his general surgery residency and a vascular surgery residency at Emory University Affiliated Hospitals, Atlanta, GA with a cardiothoracic surgery resident fellowship at Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL.
Zafir Hawa, MD, FACC, FSCAI
Dr. Hawa earned his medical degree from the University of Mumbai School of Medicine at Bombay, India. He completed his residency at the University of North Dakota Medical Center at Fargo, and a cardiology fellowship at Western Pennsylvania Hospital at Pittsburgh. He is a Fellow of the American College of Cardiology and of the Society for Cardiovascular Angiography and Interventions.
James Mitchell, MD, FACC
Dr. Mitchell received his medical degree from the University of Missouri School of Medicine – Columbia. He completed his residency at the University of Wisconsin Hospital and Clinics at Madison and a cardiology and interventional cardiology fellowship at the Texas Heart Institute at St. Luke’s Episcopal Hospital at Houston. He is a fellow of the American College of Cardiology.
Alexander Pak, MD
Dr. Pak earned his medical degree from the University of Wisconsin School of Medicine and completed his general surgery residency and a cardiothoracic fellowship at State University of New York at Buffalo.