A team of cardiologists at Missouri Baptist Medical Center (MoBap) is helping elderly patients with heart valve disease not only return to their daily lives, but become even more active. The hospital is among the first in the region and across the country to use transcatheter aortic valve replacement (TAVR), a new, minimally invasive procedure approved by the FDA in November 2011.
The TAVR procedure enables a team of cardiologists and cardiac surgeons to replace a diseased aortic heart valve less invasively—without open-heart surgery or the use of a cardiopulmonary bypass machine. Surgeons place the Edwards SAPIEN valve—the first and only FDA-approved transcatheter aortic heart valve in the nation—into a small, typically two-inch incision in the groin, then thread it through a blood vessel to the heart valve. Following the one- to two-hour surgery, the patient experiences immediate relief of the pressure in the heart that results from aortic stenosis, which if left untreated, can result in heart failure, notes Dr. Michael Mauney, a cardiothoracic surgeon at MoBap. “To watch someone come in with aortic stenosis, and in about 90 minutes, have all of their symptoms eliminated is really a revolution in how we treat valve disease.”
To date, the hospital’s cardiac team has successfully completed TAVR surgeries in almost 20 patients—ranging from ages 68 to 94—with a 95 percent six-month survival rate. While the procedure results are in their infancy, Mauney notes that none of the patients have experienced serious complications, such as stroke or kidney failure, which can arise from this type of major surgery. “Patients are back on their feet in the hospital the next day and return home in an average of five days,” Mauney says. “We’ve even had some 90-year-olds who have gone home in two days.”
TAVR is a medical advancement recommended for patients who are too frail or ill for open-heart surgery. These high-risk patients suffer from not only aortic stenosis, but other additional conditions such as lung or kidney diseases that can complicate major surgeries. More than 1.5 million people in the U.S. suffer from aortic stenosis, according to the American Medical Association. “It’s an epidemic amongst the elderly,” Mauney notes. “This new treatment option allows many of our sickest patients the opportunity to enjoy the same improvement in quality of life as those undergoing traditional open aortic valve replacement.”
After TAVR was approved by the FDA late last year, Mauney says implementing the procedure at MoBap took “incredible teamwork” from the hospital’s cardiac team, including interventional cardiologists Drs. John Hess and Robert Kopitsky, and cardiothoracic surgeons Drs. Michael Murphy and Mauney. The volume of valve replacement and repair procedures, completed both surgically and via TAVR, continues to grow at MoBap. “(TAVR) is a remarkable surgery for high-risk patients, but (traditional open-heart surgery) is still the standard of care,” Mauney notes.
MoBap also recently began offering minimally invasive mitral valve (MV) surgeries. Rather than the large incision in the middle of the chest required in open-heart surgery, this procedure is completed through a small incision on the right side of the chest, giving surgeons access between the ribs to repair or replace the valve in the heart. Among Dr. Scharff's 25 patients who have undergone the surgery, all are experiencing positive results, including relief of difficult breathing and fatigue, as well as a reduction in the risk of congestive heart failure. “There’s also a psychological benefit for patients when undergoing a less invasive procedure,” Scharff says. “Overall, this procedure may help them live longer and feel a lot better.”
In addition to TAVR and minimally invasive mitral valve surgery, MoBap’s cardiac team continues to perform traditional open-heart and redo cardiac surgeries, Mauney notes. “There isn’t anything we can’t do for somebody with valve disease.”