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TAVR: The Minimally Invasive Aortic Stenosis Treatment

Aortic stenosis is a progressive narrowing of the aortic valve opening. This constriction forces the heart to pump harder in order to get blood through the valve and out to the body. Over time, aortic stenosis can damage the heart and lead to heart failure. Until recently, the only treatment option was open-heart surgery for patients.

In this podcast, Dr. Ramon Partida, an Interventional Cardiologist at MarinHealth Medical Center, describes a new and minimally invasive procedure called transcatheter aortic valve replacement or TAVR. This intervention actually replaces the defective valve by threading a catheter through a vein in the groin, up to the heart, pushing aside the faulty valve. Find out how TAVR is giving aortic stenosis patients a new lease on life.
TAVR: The Minimally Invasive Aortic Stenosis Treatment
Featuring:
Ramon Partida, MD
Ramon Partida, MD is an interventional cardiologist with a special interest and advanced training in Structural Heart Disease. In addition to his interest in the prevention and treatment of coronary disease, he is passionate about treating diseases of the heart chambers and valves with minimally invasive therapies, including transaortic valve replacement (TAVR) and transcatheter mitral valve repair.

Learn more about Ramon Partida, MD
Transcription:

Bill (Host): Aortic stenosis is a progressive disease affecting more than 2.5 million people over the age of seventy   five in the United States. Treatment includes open heart surgery; however, the transcatheter aortic valve replacement or TAVR procedure offers hope for high risk individuals. Here to talk with us about the transcatheter aortic valve replacement or TAVR is Dr. Ramon Partida, interventional cardiologist at Marin General Hospital. Dr. Partida, thank you for your time. So first off, what is aortic stenosis?

Dr. Ramon Partida, MD (Guest): Thank you, Bill. It's, great to be here and I appreciate the invitation. So aortic stenosis is a very common and fairly prevalent problem that we deal with our heart pumps blood all over the body. And what kind of keeps things going in one direction there is the valves that are in between each chamber of the heart. And   aortic stenosis is basically a problem in which the main heart valve coming out of the heart doesn't work as well as it as it's supposed to. So essentially it's a valve that gets, stuck over time, and doesn't open well, so it makes it harder and harder for the heart to kind of do its job and be able to pump blood throughout the whole body.

Bill: So how would someone know if they have this?

Dr. Partida: It's something that happens slowly over time. So sometimes it can be a little challenging to diagnose, it kind of creeps up on you, if you will. But eventually most people with, this problem will have, one of a few main symptoms. One of the main ones would be slowly progressive, shortness of breath. So something that certainly, we all have at some point in life if we exercise too much, for example. But these people will, generally become increasingly short of breath, over time with increasingly less and less activities. That's one of the main things with the shortness of breath, like I mentioned. And some of the people can also, develop some chest discomfort, or tightness, pressure in their chest. There could be some lightheadedness and dizziness, you know? In one kind of extreme circumstance, somebody could potentially just lose consciousness or black out for some time. It's what we call syncope. So these some of the three cardinal symptoms that we look for, for patients that have the severe version of this problem.

Bill: So for someone diagnosed with this, let's talk about the TAVR procedure. Who is a good candidate for it?

Dr. Partida: We've learned over time that, more and more people are good candidates for it. We used to treat this problem with open heart surgery, like you mentioned, and as you might know, the recovery from an open heart surgery which is a major operation, can take, certainly, a week in the hospital,   probably several weeks if not months, to fully recover from the operation. So when this, we initially started doing this procedure, a little bit over ten years ago, we kind of focused our attention on patients that were not able to get, surgery because they were either too sick, or they were not a good candidate for surgery in the first place. And what we learned is that that was certainly, a much better treatment than the alternative of medications. Medications we learned don't particularly help with this problem.

Bill: So on what types of candidates did you focus on first?

Dr. Partida: So initially we focused our attention on patients that would not be able to get a surgery. And as we've sort of gone over time and realized that this is a very, very effective treatment, we've sort of lowered the bar if you will in terms of how, and risky an operation needs to be for a patient to be a candidate for uh for the TAVR procedure. So we first kind of started off with the patients that were not able to get surgery, realized that that was better than any alternative, then we said, "Gees should we kind of compare to those who are at high risk of surgery?" It turns out it was just as effective and patients did just as well. And then over time we'd say, "Well, what about kind of one step lower, in folks who would be kind of in the middle range," or what in the medical field call intermediate risk for surgery. And that's kind of where we are now where we've found that everybody who is kind of in the middle range in terms of how risky an open heart surgery would be are an approved, candidate for this procedure. So   it's   very encouraging and it's very exciting because it really provides an incredible set of options for a lot of people.

Bill: So how does the procedure work? This is minimally invasive? Certainly not as intensive as open heart surgery. For someone listening that may be considering this, or it's an option for them, how does this operation procedure work?

Dr. Partida: Absolutely. So we deliver the heart valve through a catheter that in about 90% to 95% of the cases we're able to fit through one of the blood vessels in the leg, we go in through the leg with some anesthesia, and bring the catheter all the way up to the heart, and use x- rays and ultrasound to locate exactly where the   where the valve needs to be. And the valve gets set right in place of where the old valve that, wasn't working would be.

Bill: So what happens to the old valve then?

Dr. Partida: Essentially what we do is we kind of push the old valve out of the way and place, the new valve right there in that same spot, and uh the procedure takes approximately an hour and right after that, patient has a new heart valve. We essentially eliminatethe problem of the aortic stenosis, through a relatively, minimally invasive procedure, as you will. Then after the valve is set and done the catheters get removed, there's a little stitch that gets placed in the place where we introduced the catheter in the leg area, and approximately six hours afterwards, the patient is immediately awake, and with it. And then about, four to six hours later, we expect the patient to be sitting up and walking around, in the room.

Bill: And then generally, how long is the person in the hospital?

Dr. Partida: depending on what other medical problems and so forth the patient might have,    the expected stay in the hospital is probably in the order of, one to two days for the majority of patients. And then after that, again the vast majority, of folks is able to go back home and continue on with their life. So their recovery is one of the most remarkable things, where it involves essentially a one to two day hospitalization for the vast majority of patients. In the minority of patients in which we're not able to either fit the catheter, for example, through the,   the blood vessel in the leg, there are other alternatives but that tends to the minority of cases, because nowadays we're essentially on the third generation of third iteration of this technology, and we're really able to kind of, deliver and do the procedure in the way that I described which has been shown to be the most, effective and efficient, for most.

Bill: Totally amazing. Dr. Partida, thank you so much for your time today and talking with us about the TAVR procedure. For more information, visit www.MarinGeneral.org. That's www.MarinGeneral.org. This is The Healing Podcast, brought to you by Marin General Hospital. I'm Bill Klaproth, thanks for listening.