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TAVR
Dr. Rahul Gaglani explains what a TAVR procedure is, Temeculas experience with TAVR, when TVH started doing TAVR, and what the outcomes have been.
Featured Speaker:
Learn more about Rahul Gaglani, MD
Rahul Gaglani, MD
Dr. Gaglani completed his Internal Medicine residency at St. Vincents Medical Center in New York and went on to NewYork-Presbyterian Brooklyn Methodist Hospital for his General and Interventional Cardiology fellowships.Learn more about Rahul Gaglani, MD
Transcription:
Melanie Cole (Host): If you’ve been told you have valve disease and are not a candidate for certain types of heart surgery, TAVR, or transcatheter aortic valve replacement, may be an option to discuss with your physician. My guest today is Dr. Rahul Gaglani. He’s an interventional cardiologist, and he’s a member of the medical staff at Temecula Valley Hospital. Dr. Gaglani, what a pleasure to have you join us today. Give us a little bit of a physiology lesson. What do our heart valves do? What’s their main function?
Rahul Gaglani MD (Guest): So, the aortic valve is basically the valve that is separating the left ventricle, which is the main heart function or contractility of the heart, from the aorta, which is the main artery of the whole body. In terms of that valve, it’s very important in terms of providing circulation throughout the body. Now, that valve, the main issue is that when we’re talking about transaortic valve replacement or TAVR, that valve can become stenotic or obstructed, and that happens over years or could be a congenital abnormality. In terms of it happening over years, it becomes calcified and very stenotic or obstructed. When it does that, it decreases the flow of circulation of blood throughout the rest of the body. At that point, the symptoms that you’d be feeling are shortness of breath, fatigue, lethargy, and you can even feel dizziness and pass out.
Melanie: That was an excellent explanation. So, Dr. Gaglani, who’s at risk for valve disease, and you mentioned some of those symptoms—they could be anything. So, when would a person go see a doctor about this?
Dr. Gaglani: In terms of who’s at risk, it’s usually the elderly population, and I’m talking about above 60 or 70 years old, and it’s not every 60 or 70-year-old—it’s the comorbidities that they have. So, it’s diabetic patients. It’s the patient that has end-stage renal disease. It’s the patient that has prior coronary artery disease or disease in the arteries of the legs or the carotids. So, it’s a patient that basically has overall atherosclerosis, which is basically plaque or calcification in the arteries of the heart. These are the patients that would typically have aortic stenosis, and the symptoms, as I mentioned, would be shortness of breath or exertional symptoms in terms of having exertional chest pain, having dizziness or lightheadedness or shortness of breath on that exertional activity, and the issue is that some of these symptoms could be really subtle in the sense that the exercise tolerance that you were able to do six months or a year has become decreased, and so picking up those subtle symptoms is the hard part.
Melanie: So, then, tell us a little bit about the TAVR procedure that I mentioned in the intro. What is that, and who is it for?
Dr. Gaglani: So, the TAVR procedure was initially for those patients that were considered inoperable or high-risk. So, a patient that initially thought was a good candidate for valve replacement, but because of their comorbidities or their age made them a high risk or inoperable candidate. After the years it’s become more towards the intermediate population, and within the past couple of months, it’s actually becoming the low-risk population, so that this point a TAVR procedure is as equivalent to open heart surgery. We typically talk to the patient, present them both options, but in one sense, the TAVR procedure, the recovery is a lot quicker and the overall procedure is not entailing in one sense that the chest is not opened. The procedure is done via the groin. So, in terms of the procedure itself, there is a tube that is placed in the groin. From that tube, we’re able to bring a device into the aorta and to the aortic valve, and basically replace the previous aortic valve, and this is all done through the groin in which the procedure is, you know, approximately about two hours, and the recovery process is a lot sooner in the sense that you’ll be able to go home the next day.
Melanie: Isn’t that amazing what you can do now? Dr. Gaglani, tell us a little bit about Temecula’s experience with TAVR and how have been your outcomes?
Dr. Gaglani: So, we first did our TAVR procedure in August of this year. The case went very well. It was a patient that had significant shortness of breath, weakness, fatigue, that’s been going on for a year or two and had been really debilitated by this shortness of breath that his exertional activity level was basically homebound, and after the procedure, he was able to exert himself quite differently in the sense that he was able to go outside, do activities. Previous, he was using a walker or a cane and after the procedure, literally two weeks after the procedure, he no longer needed the cane or walker to walk around. So, tremendous difference in his functional status, his lifestyle, and his overall attitude, and what he thought he was able to do in his daily living.
Melanie: Is there anything that patients need to change after this procedure? What is life like after for them and give us your best advice—people who are considering this and are not sure what questions to ask?
Dr. Gaglani: So, in terms of their life after the TAVR procedure, it’s mostly monitoring the valves and their symptoms. So, in terms of monitoring the valves, we do a sonogram or an ultrasound or an echo of the heart to make sure that the valve is working appropriately, and then, in terms of what they need to do going forward is pretty much live a healthy lifestyle, and I know that word “healthy lifestyle” is very vague, but in a sense of good diet control, exercise routinely and then following up with their cardiologist and listening [for] (6:26) those symptoms that they had before because the symptoms that they were having before are the same symptoms that they would have if there’s an issue with the valve that they got replaced.
Melanie: Wow. As I said before, it really is amazing—what great advice, Dr. Gaglani. Thank you so much for joining us and sharing your expertise. It’s such an interesting topic. Thank you again, and that wraps up this episode of TVH Health Chat with Temecula Valley Hospital. Head on over to our website at temeculavalleyhospital.com for more information on the TAVR procedure and to get connected with one of our providers. If you found this podcast as interesting and educational as I did, please share with your friends and family. Share on social media. That way we all learn together from the experts at Temecula Valley Hospital and don’t miss all the other interesting podcasts in our library. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. Thanks for listening, this is Melanie Cole.
Melanie Cole (Host): If you’ve been told you have valve disease and are not a candidate for certain types of heart surgery, TAVR, or transcatheter aortic valve replacement, may be an option to discuss with your physician. My guest today is Dr. Rahul Gaglani. He’s an interventional cardiologist, and he’s a member of the medical staff at Temecula Valley Hospital. Dr. Gaglani, what a pleasure to have you join us today. Give us a little bit of a physiology lesson. What do our heart valves do? What’s their main function?
Rahul Gaglani MD (Guest): So, the aortic valve is basically the valve that is separating the left ventricle, which is the main heart function or contractility of the heart, from the aorta, which is the main artery of the whole body. In terms of that valve, it’s very important in terms of providing circulation throughout the body. Now, that valve, the main issue is that when we’re talking about transaortic valve replacement or TAVR, that valve can become stenotic or obstructed, and that happens over years or could be a congenital abnormality. In terms of it happening over years, it becomes calcified and very stenotic or obstructed. When it does that, it decreases the flow of circulation of blood throughout the rest of the body. At that point, the symptoms that you’d be feeling are shortness of breath, fatigue, lethargy, and you can even feel dizziness and pass out.
Melanie: That was an excellent explanation. So, Dr. Gaglani, who’s at risk for valve disease, and you mentioned some of those symptoms—they could be anything. So, when would a person go see a doctor about this?
Dr. Gaglani: In terms of who’s at risk, it’s usually the elderly population, and I’m talking about above 60 or 70 years old, and it’s not every 60 or 70-year-old—it’s the comorbidities that they have. So, it’s diabetic patients. It’s the patient that has end-stage renal disease. It’s the patient that has prior coronary artery disease or disease in the arteries of the legs or the carotids. So, it’s a patient that basically has overall atherosclerosis, which is basically plaque or calcification in the arteries of the heart. These are the patients that would typically have aortic stenosis, and the symptoms, as I mentioned, would be shortness of breath or exertional symptoms in terms of having exertional chest pain, having dizziness or lightheadedness or shortness of breath on that exertional activity, and the issue is that some of these symptoms could be really subtle in the sense that the exercise tolerance that you were able to do six months or a year has become decreased, and so picking up those subtle symptoms is the hard part.
Melanie: So, then, tell us a little bit about the TAVR procedure that I mentioned in the intro. What is that, and who is it for?
Dr. Gaglani: So, the TAVR procedure was initially for those patients that were considered inoperable or high-risk. So, a patient that initially thought was a good candidate for valve replacement, but because of their comorbidities or their age made them a high risk or inoperable candidate. After the years it’s become more towards the intermediate population, and within the past couple of months, it’s actually becoming the low-risk population, so that this point a TAVR procedure is as equivalent to open heart surgery. We typically talk to the patient, present them both options, but in one sense, the TAVR procedure, the recovery is a lot quicker and the overall procedure is not entailing in one sense that the chest is not opened. The procedure is done via the groin. So, in terms of the procedure itself, there is a tube that is placed in the groin. From that tube, we’re able to bring a device into the aorta and to the aortic valve, and basically replace the previous aortic valve, and this is all done through the groin in which the procedure is, you know, approximately about two hours, and the recovery process is a lot sooner in the sense that you’ll be able to go home the next day.
Melanie: Isn’t that amazing what you can do now? Dr. Gaglani, tell us a little bit about Temecula’s experience with TAVR and how have been your outcomes?
Dr. Gaglani: So, we first did our TAVR procedure in August of this year. The case went very well. It was a patient that had significant shortness of breath, weakness, fatigue, that’s been going on for a year or two and had been really debilitated by this shortness of breath that his exertional activity level was basically homebound, and after the procedure, he was able to exert himself quite differently in the sense that he was able to go outside, do activities. Previous, he was using a walker or a cane and after the procedure, literally two weeks after the procedure, he no longer needed the cane or walker to walk around. So, tremendous difference in his functional status, his lifestyle, and his overall attitude, and what he thought he was able to do in his daily living.
Melanie: Is there anything that patients need to change after this procedure? What is life like after for them and give us your best advice—people who are considering this and are not sure what questions to ask?
Dr. Gaglani: So, in terms of their life after the TAVR procedure, it’s mostly monitoring the valves and their symptoms. So, in terms of monitoring the valves, we do a sonogram or an ultrasound or an echo of the heart to make sure that the valve is working appropriately, and then, in terms of what they need to do going forward is pretty much live a healthy lifestyle, and I know that word “healthy lifestyle” is very vague, but in a sense of good diet control, exercise routinely and then following up with their cardiologist and listening [for] (6:26) those symptoms that they had before because the symptoms that they were having before are the same symptoms that they would have if there’s an issue with the valve that they got replaced.
Melanie: Wow. As I said before, it really is amazing—what great advice, Dr. Gaglani. Thank you so much for joining us and sharing your expertise. It’s such an interesting topic. Thank you again, and that wraps up this episode of TVH Health Chat with Temecula Valley Hospital. Head on over to our website at temeculavalleyhospital.com for more information on the TAVR procedure and to get connected with one of our providers. If you found this podcast as interesting and educational as I did, please share with your friends and family. Share on social media. That way we all learn together from the experts at Temecula Valley Hospital and don’t miss all the other interesting podcasts in our library. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. Thanks for listening, this is Melanie Cole.