Selected Podcast
Life Before and After a TAVR
Dr. William Suh, an interventional cardiologist with Temecula Valley Hospital, discusses TAVR Shockwave Technology.
Featured Speaker:
William Suh, MD
William Suh, MD Specialties include Interventional Cardiology, Structural Heart Disease and Interventions, Transcatheter Aortic Valve Replacement, TAVR. Transcription:
Melanie Cole, MS (Host): Welcome to TVH Healthchat with Temecula Valley Hospital. I'm Melanie Cole, and today we’re discussing TAVR and shockwave technology. Life before and after a TAVR. What this is like for patients. Joining me is Dr. William Suh. He’s an interventional cardiologist and a member of medical staff at Temecula Valley Hospital. Dr. Suh, I’d like to start with a little physiology lesson as it were for the listeners. What do our heart valves do? Explain a little bit about how they fail and who might be at risk for heart valve disease?
William Suh, MD (Guest): So there are four main valves to the heart. The aortic valve is the main outflow valve of the heart. The aortic valve is the main outflow valve of the heart. The left ventricle pumps through the aortic valve and then the aorta delivers oxygenated blood to the rest of the body. The ways that an aortic valve can fail is one, it can have a leak. That’s called aortic regurgitation. Another way that it could fail is to be stenotic where the valve doesn’t open as well as it should. Older people, as they age, the valve can get thickened and calcified. Those valve leaflets don’t open as far as they should, and that’s what causes pressure buildup in the ventricle and in the heart. So patients will often feel chest pain, shortness of breath, or have fainting episodes that are the symptoms related to severe aortic stenosis.
Host: So then what had been the standard treatment for a failed valve? Thank you so much for that answer, by the way. What can be done now for certain people? Tell us about TAVR because this is really a very interesting procedure.
Dr. Suh: So TAVR is spelled T-A-V-R. It stands for transcatheter aortic valve replacement. It is an alternative therapy to the traditional open heart surgery and surgical aortic valve replacement. So the TAVR procedure was first performed in France in 2002. Since then the technology has really rapidly been developed over the last 18 years. So this is a very exciting technology in which patients originally who were not surgical candidates were treated with the TAVR procedure. Through multiple clinical trials, now we’re able to offer this procedure in even low risk surgical patients. So many patients because of the less invasive nature of the TAVR procedure often will choose to have TAVR instead of the traditional open heart surgery.
Host: So if you are replacing a valve, Dr. Suh, and there’s a lot of calcium in the veins, in these arteries. You're replacing a valve. How do these devices get in there if there’s calcification all the way around? Tell us a little bit about shockwave technology and how it helps to really enable that access for TAVR and how it helps you to get vessel expansion while you're doing what you need to do.
Dr. Suh: So calcium is actually important in how the valve is implanted because it’s the calcium within the valve leaflets that actually allows the valve to be anchored when we put a stent inside the diseased valve. Calcium in the leg arteries, which is the usual approach that we take to do the TAVR procedure, can make things more difficult in advancing our interventional equipment. So as you stated, if there is a lot of calcium that’s surrounding the whole artery and it prohibits the delivery sheath to be advanced to the aorta, that could make things very difficult from a groin approach. Often times we have to look at alternative approaches like subclavian or axillary artery. Now what's become more popular is the trans carotid approach where we go through the neck artery. What's exciting about shockwave is that this technology is able to deliver a high energy sound wave to break up the calcium that’s in the leg arteries and allows us to keep the procedure in the groin and away from the alternate access. We know that patients that are treated from the groin approach is the safest way to do TAVR. There is less stroke and there is also a lower mortality when you treat the patients from a femoral approach rather than alternative access. So shockwave really has been able to help us achieve good outcomes.
Host: Then tell us a little bit about the SAPIEN 3 Ultra, which is a newer version of the Edwards TAVR valve. Really because all of this is so exciting, and listeners may not really understand how exciting your field is.
Dr. Suh: Yes. So the original SAPIEN valve had a stainless steel cage that did not have an outer skirt that would help prevent leak around the valve when the valve was implanted. SAPIEN 3 is the third generation valve that did have this outer sealing skirt. The new SAPIEN 3 Ultra, the skirt is a little bit taller. The skirt is now textured. So because of those two characteristics, the valve is able to get a better seal and there's less paravalvular leak after the valve procedure. We know that in patients that have severe or moderate paravalvular leak, the long term outcomes are not as good. So we want to try to mimic a surgical result and not to have any leak. So the SAPIEN 3 Ultra is able to achieve that in more patients.
Host: Isn’t that fascinating? Now let’s talk about what life is like for a patient before having TAVR and after. What have you seen as far as outcomes and quality of life Dr. Suh?
Dr. Suh: So that’s a great question. So oftentimes patients will feel fatigued, shortness of breath, low energy before having the valve procedure, the TAVR procedure done. Once the valve is put in, it’s usually an overnight stay in the hospital and many times the patients are telling us that even the next day they feel so much more energy, they're breathing is easier. One of the common things is that they say that they’ve finally gotten a full nights sleep after having the valve procedure done. We often times see that there's better color in their complexion meaning that their head is getting more blood flow. So the immediate benefits are seen oftentimes. There are certain cases where the patients don’t benefit as much because there are other things going on whether it be lung disease or other factors that are causing them to not feel well. The vast majority of patients almost on day two after the procedure are feeling a lot better. We know that patients that are not treated in the long term, they do have a high mortality if the aortic stenosis is not treated. So this really is a procedure that helps people live longer as well as feel better.
Host: Isn’t that amazing what you can do now? Who does these procedures. I introduced you as an interventional cardiologist. Will you explain what that is for the listeners and the difference between an interventional cardiologist, a cardiologist, and a cardiothoracic surgeon? Tell us a little bit about your field.
Dr. Suh: Sure. So an interventional cardiologist is a cardiologist that did additional training so that we’re able to perform catheter based procedures. So we do not use a scalpel and make any incisions in the body. The transcatheter aortic valve replacement procedure is actually done by a heart team. The heart team consists of an interventional cardiologist, a cardiac surgeon, a cardiac anesthesiologist, as well as our imaging cardiologist. So there's a lot of different people involved in the care of our TAVR patients as a heart team. The cardiac surgeon, they do open heart surgery. They can do very complex repairs when there are multiple problems with the heart, but oftentimes now we’re making decisions about our patients as a heart team. When we get more people involved, we’re able to brainstorm, come up with the best solution for an individual patient.
Host: As we wrap up, Dr. Suh, let the listeners know what you would like them to know about the TAVR procedure should they need a valve replacement. Really the fascinating part of this technology that is shockwave technology that really to helps you get that valve in place.
Dr. Suh: What I would the take home message to be to our patients is that if there are any symptoms related to the heart and potentially to the aortic valve is not to wait to seek consultation with your doctor, with a cardiologist, and get an evaluation. This is a therapy that can be lifesaving. Then the shock wave technology, again, is just another example of how medical technology is advancing to be able to provide superior outcomes and to make the lives of patients as well as the lives of the practicing physicians easier to help people feel better.
Host: Thank you so much Dr. Suh for coming on today and sharing your incredible expertise. Thank you again. That concludes this episode of TVH Healthchat with Temecula Valley Hospital. Please visit our website at temeculavalleyhospital.com for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other Temecula Valley Hospital podcasts. 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. I'm Melanie Cole.
Melanie Cole, MS (Host): Welcome to TVH Healthchat with Temecula Valley Hospital. I'm Melanie Cole, and today we’re discussing TAVR and shockwave technology. Life before and after a TAVR. What this is like for patients. Joining me is Dr. William Suh. He’s an interventional cardiologist and a member of medical staff at Temecula Valley Hospital. Dr. Suh, I’d like to start with a little physiology lesson as it were for the listeners. What do our heart valves do? Explain a little bit about how they fail and who might be at risk for heart valve disease?
William Suh, MD (Guest): So there are four main valves to the heart. The aortic valve is the main outflow valve of the heart. The aortic valve is the main outflow valve of the heart. The left ventricle pumps through the aortic valve and then the aorta delivers oxygenated blood to the rest of the body. The ways that an aortic valve can fail is one, it can have a leak. That’s called aortic regurgitation. Another way that it could fail is to be stenotic where the valve doesn’t open as well as it should. Older people, as they age, the valve can get thickened and calcified. Those valve leaflets don’t open as far as they should, and that’s what causes pressure buildup in the ventricle and in the heart. So patients will often feel chest pain, shortness of breath, or have fainting episodes that are the symptoms related to severe aortic stenosis.
Host: So then what had been the standard treatment for a failed valve? Thank you so much for that answer, by the way. What can be done now for certain people? Tell us about TAVR because this is really a very interesting procedure.
Dr. Suh: So TAVR is spelled T-A-V-R. It stands for transcatheter aortic valve replacement. It is an alternative therapy to the traditional open heart surgery and surgical aortic valve replacement. So the TAVR procedure was first performed in France in 2002. Since then the technology has really rapidly been developed over the last 18 years. So this is a very exciting technology in which patients originally who were not surgical candidates were treated with the TAVR procedure. Through multiple clinical trials, now we’re able to offer this procedure in even low risk surgical patients. So many patients because of the less invasive nature of the TAVR procedure often will choose to have TAVR instead of the traditional open heart surgery.
Host: So if you are replacing a valve, Dr. Suh, and there’s a lot of calcium in the veins, in these arteries. You're replacing a valve. How do these devices get in there if there’s calcification all the way around? Tell us a little bit about shockwave technology and how it helps to really enable that access for TAVR and how it helps you to get vessel expansion while you're doing what you need to do.
Dr. Suh: So calcium is actually important in how the valve is implanted because it’s the calcium within the valve leaflets that actually allows the valve to be anchored when we put a stent inside the diseased valve. Calcium in the leg arteries, which is the usual approach that we take to do the TAVR procedure, can make things more difficult in advancing our interventional equipment. So as you stated, if there is a lot of calcium that’s surrounding the whole artery and it prohibits the delivery sheath to be advanced to the aorta, that could make things very difficult from a groin approach. Often times we have to look at alternative approaches like subclavian or axillary artery. Now what's become more popular is the trans carotid approach where we go through the neck artery. What's exciting about shockwave is that this technology is able to deliver a high energy sound wave to break up the calcium that’s in the leg arteries and allows us to keep the procedure in the groin and away from the alternate access. We know that patients that are treated from the groin approach is the safest way to do TAVR. There is less stroke and there is also a lower mortality when you treat the patients from a femoral approach rather than alternative access. So shockwave really has been able to help us achieve good outcomes.
Host: Then tell us a little bit about the SAPIEN 3 Ultra, which is a newer version of the Edwards TAVR valve. Really because all of this is so exciting, and listeners may not really understand how exciting your field is.
Dr. Suh: Yes. So the original SAPIEN valve had a stainless steel cage that did not have an outer skirt that would help prevent leak around the valve when the valve was implanted. SAPIEN 3 is the third generation valve that did have this outer sealing skirt. The new SAPIEN 3 Ultra, the skirt is a little bit taller. The skirt is now textured. So because of those two characteristics, the valve is able to get a better seal and there's less paravalvular leak after the valve procedure. We know that in patients that have severe or moderate paravalvular leak, the long term outcomes are not as good. So we want to try to mimic a surgical result and not to have any leak. So the SAPIEN 3 Ultra is able to achieve that in more patients.
Host: Isn’t that fascinating? Now let’s talk about what life is like for a patient before having TAVR and after. What have you seen as far as outcomes and quality of life Dr. Suh?
Dr. Suh: So that’s a great question. So oftentimes patients will feel fatigued, shortness of breath, low energy before having the valve procedure, the TAVR procedure done. Once the valve is put in, it’s usually an overnight stay in the hospital and many times the patients are telling us that even the next day they feel so much more energy, they're breathing is easier. One of the common things is that they say that they’ve finally gotten a full nights sleep after having the valve procedure done. We often times see that there's better color in their complexion meaning that their head is getting more blood flow. So the immediate benefits are seen oftentimes. There are certain cases where the patients don’t benefit as much because there are other things going on whether it be lung disease or other factors that are causing them to not feel well. The vast majority of patients almost on day two after the procedure are feeling a lot better. We know that patients that are not treated in the long term, they do have a high mortality if the aortic stenosis is not treated. So this really is a procedure that helps people live longer as well as feel better.
Host: Isn’t that amazing what you can do now? Who does these procedures. I introduced you as an interventional cardiologist. Will you explain what that is for the listeners and the difference between an interventional cardiologist, a cardiologist, and a cardiothoracic surgeon? Tell us a little bit about your field.
Dr. Suh: Sure. So an interventional cardiologist is a cardiologist that did additional training so that we’re able to perform catheter based procedures. So we do not use a scalpel and make any incisions in the body. The transcatheter aortic valve replacement procedure is actually done by a heart team. The heart team consists of an interventional cardiologist, a cardiac surgeon, a cardiac anesthesiologist, as well as our imaging cardiologist. So there's a lot of different people involved in the care of our TAVR patients as a heart team. The cardiac surgeon, they do open heart surgery. They can do very complex repairs when there are multiple problems with the heart, but oftentimes now we’re making decisions about our patients as a heart team. When we get more people involved, we’re able to brainstorm, come up with the best solution for an individual patient.
Host: As we wrap up, Dr. Suh, let the listeners know what you would like them to know about the TAVR procedure should they need a valve replacement. Really the fascinating part of this technology that is shockwave technology that really to helps you get that valve in place.
Dr. Suh: What I would the take home message to be to our patients is that if there are any symptoms related to the heart and potentially to the aortic valve is not to wait to seek consultation with your doctor, with a cardiologist, and get an evaluation. This is a therapy that can be lifesaving. Then the shock wave technology, again, is just another example of how medical technology is advancing to be able to provide superior outcomes and to make the lives of patients as well as the lives of the practicing physicians easier to help people feel better.
Host: Thank you so much Dr. Suh for coming on today and sharing your incredible expertise. Thank you again. That concludes this episode of TVH Healthchat with Temecula Valley Hospital. Please visit our website at temeculavalleyhospital.com for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other Temecula Valley Hospital podcasts. 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. I'm Melanie Cole.