TAVR - A New Heart Valve Replacement Procedure at Henry Mayo

Transcription:

Melanie Cole (Host): Henry Mayo Newhall Hospital recently began offering a new minimally invasive heart valve replacement procedure called TAVR for patients who qualify. Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole and joining me in this panel today is Dr. Abhi Shak Sinha. He's an Interventional Cardiologist and Structural Heart Director at Henry Mayo Newhall Hospital and Dick Sears, who recently underwent a TAVR procedure.

Gentlemen, thank you so much for joining us today. Dick, I want to start with you. Tell us your story and why you were treated at Henry Mayo Newhall Hospital. Tell us a little bit about your experience.

Dick Sears (Guest): About a year ago, I started feeling well, not too well. I couldn't go out in the yard and work like I used to and my wife would said, you know, why are you coming into the house so soon after just a short period of time, but I was just for that about a year, I just felt lethargic and didn't have any energy whatsoever. Then because of COVID where you, we didn't have a lot of contact with the doctor and about six months ago it really got so that I couldn't really walk or do any kind of work without stopping to catch my breath.

And so and echocardiogram was made and it revealed that my aortic heart valve was not functioning properly. And it was a lot of calcification and it wasn't closing properly and it was causing of what they call a stiff valve. So, they immediately thought that I was a candidate for TAVR and they put me in touch with Dr. Sinha and he determined that indeed it should be done. And post haste, basically, this was in May of this year. And so I was then scheduled for testing and it seemed like the, all the tests revealed that yes, indeed was something that I really had to do if I wanted to have a quality life.

And so, it was scheduled for July the 15th, I think it was. And there wasn't not a lot of testing after that. I went through the surgery and let me tell you the cardiac group there in Henry Mayo, they are just wonderful. I've never been in a hospital that I received, such great care.

And Dr. Sinha, his personality is such that really puts you at ease and you're calm and you don't worry about those kinds of things. And it was just a great treatment that I got and it seemed like that only took a few minutes to do the surgery, but that wasn't the case. Because from the surgery, why I was already in recovery and it I don't think I ever did find out how long it really took. An hour and a half, I think I did hear, but anyway, so these, the surgery was successful and I'm just so grateful that I had the team that I had seemed like everyone had something to do.

And that I was surrounded by.. I would say, I thought maybe hundreds of people, but that really wasn't the case. There was, I don't know how many was in the team, maybe a dozen or so, but they all had a job to do, and it was like a well-oiled machine. They just, they knew exactly what to do there. They had received training, I understand to do this. And it was just perfect. And believe it or not, I didn't have a bit of pain anywhere or at any time during this whole process, simply pain-free so that I'm very thankful for.

Host: Wow. What a story, Dick. Thank you so much for telling us all about that. Now, Dr. Sinha is Dick's story different than most that you see with similar situations? I'd like you to tell us the TAVR procedure that Dick had, is it considered minimally invasive? Tell us a little bit about this procedure.

Abhi Sinha, MD (Guest): Thank you, Melanie. Thank you for the opportunity and it's a pleasure to be here and thank you, Mr. Sears for you know, being willing to share your story as well. The TAVR procedure stands for transcatheter aortic valve replacement. And it's an alternative to open-heart surgery. And essentially what it involves is a valve that's collapsible.

And because of that, it folds into a catheter. And so it can be done through a minimally invasive approach as opposed to open heart surgery where you have to cut the sternum. You can usually go into a vessel, usually the artery in the leg, but there's other approaches like you can go through the artery, the subclavian artery or even the carotid artery.

But it can be done often through a percutaneous approach, which means we don't have to dissect into the artery. We can just use needles, wires, and catheters. That facilitates recovery quite a bit. This procedure has essentially revolutionized the world of structural heart interventions over the last decade. It was really first introduced into the US through the partner's trial, which was back about 10 years ago. I was a fellow at the University of Washington when we were one of the partner sites and that's when some of the earliest trials were occurring.

And I think it was pretty clear after the first few cases that this is going to change the way that we treat valve disease. At first, there was, you know, a certain amount of skepticism about whether it would work and then the you know, we realized that it does work. And then after that, there was a question of whether or not there would be a durable result.

And so far, we are seeing that the procedure works and there's durable results. Over time, the procedure has improved. The valves have improved. The catheters has gotten smaller, the procedure's gotten streamlined. And what we've seen is that in 2011, it was approved only for high risk patients, meaning patients were either not candidates for surgery or patients who, you know, would be high risk for surgery, or surgical complications. And then in 2016, as the procedure got better, as the valves got better, it got approved for intermediate risk patients. So patients who were at lower risk. And what we found is that was the first time we started to see some advantages of this in compared to surgery.

And then in 2019, it got approved for low risk patients. So, these are patients who wouldn't necessarily be high risk for surgery. But we actually saw a benefit in doing this procedure over surgery on some of these patients and the benefit was we saw a lower composite on death, stroke and rehospitalizations in 30 days. We saw decreased hospital stay on average with this procedure, people would stay for maybe about three days as opposed to seven days with surgery. They had a better quality of life sooner and the hospital readmissions were less too. And as a result of all this, the TAVR procedure has actually become more common than surgical valve replacement that occurred in about 2019.

And as the procedure's gotten better, the mortality and results have gotten better. Back in 2011 in the TVT registry, which is where they keep track of all the procedures that are done, the 30 day mortality was about 7.5%. And now it's dropped to in 2019 about 2.5%. And some studies show that it's even lower than that in low risk patients, maybe like a one, 1% or so.

To really appreciate what this procedure does, you have to understand what aortic stenosis is and you know, Mr. Sears did mention, a calcification in the valve. And I think most people know that the heart has four chambers and four valves and there's a right side and there's a left side.

So, blood comes to the right side first, gets pumped to the lungs where it gets oxygen comes back to the left side. The main pumping chamber is called the left ventricle. And before the blood can leave the heart, it has to go out the aortic valve. So, that's the last valve before blood can leave the heart and most aortic valves have three leaflets, looks like a Mercedes-Benz sign and they open and close, but if they're calcified, the leaflets can't open all the way.

And so blood has trouble leaving the heart and you can measure how tight the valve is because the tighter the valve, the higher the pressure across it. It's kind of like a nozzle, the tighter, the nozzle, the higher, the pressure. So, there's calculations we do. And if the valve area is less than one centimeter squared, then it's severe or a mean gadient greater in 40.

And once people have severe aortic stenosis, at first they may not have symptoms but eventually they will have symptoms. And the story, Mr. Sears shared is actually very common. What people will notice initially, they'll get more short of breath. They noticed a decrease in energy, decrease in exercise tolerance.

They'll notice themselves slowing down. It progresses. If it doesn't get treated, then the symptoms get worse. They'll get chest pressure. They'll get lightheaded. They could pass out. And the final stage, the worst thing would be if they develop heart failure and then they're going to be short of breath at rest in all the time.

And then they lose perfusion to the rest of the body. And once those symptoms occur, it starts affecting their lifespan. So at one year, if it's untreated, the mortality from this is about 25%. At two years, if it's untreated, it's about 50%. And if they're a high risk, it could even be 50% mortality at one year.

And if you compare this to even metastatic cancer, if you compared the five-year survival and this condition is not treated, it actually has a worse five-year survival than a lot of metastatic cancer. But when they get treated with a valve replacement, whether it's surgical or TAVR, their survival goes back to what it would be if they didn't have the valve disease to begin with, provided they get treated in a timely fashion.

Host: Isn't medical technology amazing? I just get fascinated all the time. So Dick, tell us a little bit about how you feel now and I'd like you to briefly tell us really what in particular stood out about the care that you received at Henry Mayo Newhall Hospital.

Dick: Well, I'm, I feel really great. It's now about four weeks post-op and I feel so much better. I was only in the hospital two nights, went in on Thursday and was discharged on Saturday afternoon. So, it's amazing. You mentioned that what the medical profession is doing now, it's just unbelievable.

Anyway, now after four weeks, post-op, I'm exercising, I'm walking more. I do some light yard work and all without having to stop to catch my breath. Isn't that great. I just, I feel

Host: is.

Dick: And the thing that sticks out in my mind is the care that you get at Henry Mayo Hospital. I tell you Maria and I, my wife and I have been volunteers there for a combination of about 30 years, I guess. And we love Henry Mayo Hospital. And it's so wonderful now that this is available to our community, this type of surgery. And it's never been here before, as you know, but it's great. I was the fourth patient in line to get this and the care I received from Henry Mayo has been just wonderful.

Now I've completed two weeks of cardiac rehab right here on the campus, I might add. And that's another jewel at Henry Mayo. And I'm really looking forward to regaining my strength and stamina, and really it's exciting for me to see the progress I'm making. So I can, again, you know, have a quality life. It's, I don't think anyone can ask for anything more than that.

Host: And what would you like to tell Dr. Sinha?

Dick: I just want him to know how much Maria and I appreciate what he's done, how he's handled the whole situation. He has such a calming effect, personality that the minute we met him, we just felt at ease because it's a delicate thing to talk about. I mean, it's your life and I wouldn't say in his hands, but it's your life that you're considering there, but he just made us feel so wonderful. And we did not hesitate to progress with this surgery. It just has been so great.

Host: And Dr. Sinha, I would like the last word to be to you. What would you like to tell Dick and other patients that are having some of the symptoms that he had, and that have been looking for answers and searching for ways that they can have a valve replacement and not be this open heart surgery of the past. Tell them what you'd like them to know about the TAVR procedure at Henry Mayo Newhall Hospital.

Dr. Sinha: Well, Mr. Sears, I'm glad to hear that you're doing so much better. And I think that's one of the most gratifying parts of this procedure is just to see the improvement with patients afterwards and, you know, most of them express what Mr. Sears have said that, you know, they knew, notice improved energy.

They get to do things that they used to do again. Sometimes patients, it's their family members will notice the difference. I've had patient's family members say, well, I noticed that he or she sits up right more they're, you know, more awake, more attentive. So, it's great to kind of see patients, you know, go back to their usual life.

What I would say to patients is you know, if you feel like you're getting more tired, more short of breath you should see your doctor and, you know, if they hear a murmur, it gets most of the times, if you have severe aortic stenosis you should have a murmur, then they should refer you to your cardiologist and you should have an echocardiogram to determine if you have this disease aortic stenosis.

If you do have it and it's severe, then it's better not to wait. I think that's the thing that I could probably would want to emphasize the most that the patients who haven't done as well as others are people who've waited either because they were you know, worried about the procedure or they're, you know, they felt that, oh, my symptoms are so bad.

One thing that we see commonly is that people start limiting themselves and they don't realize it. And they'll say, well, you know, they are, their echo will say that they have a really tight aortic valve, and then they'll say, well, I don't feel so bad. What they don't realize is that they've limited themselves over the last three months, six months, even a year.

And they don't realize that. And then, you know, sometimes you can prove it to them. Like you can put them on a treadmill and say, well, let's see how you do. And then when they start walking, they'll say, oh, well, I didn't realize this. And then when they get their valve fixed, they'll say, wow, I haven't felt this good in you know, six months or a year. I've had patients say, you know, I haven't felt this good in two years. So it's important to realize that. The other thing to keep in mind is that, you know, because of all the advances in technology and the procedure and optimization of that, you know, the procedure has become a lot safer.

And as Mr. Sears has attested, you know, the recovery is relatively, you know, after the procedure, you'll be on bed rest for a period of time, but, you know, it'll be up and walking around usually by the next day. And, you know, patients, a lot of them the majority at Henry Mayo have gone home within 48 hours.

And that's included you know, patients even with, you know, a lot of other issues. So, I think that the more, the most important thing is to get evaluated soon. And if you need it don't put it off. Because I have seen, you know, patients who have put it off, they don't do as well. They don't, it takes them a lot longer to recover. So I think those are the main things to emphasize.

Host: Thank you both so much. Thank you Dick for coming on and telling us your story and Dr. Sinha for telling us about this amazing procedure that's now available at Henry Mayo Newhall Hospital. And for more information you can visit Henrymayo.com/heart and get some information about the TAVR procedure. It's pretty fascinating.

That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. For more health tips and updates, follow us on your social channels. I'm Melanie Cole. Thanks so much for listening.