Daily Dose – Atrium Health Sanger Heart & Vascular Institute performs more than 2,000 TAVI procedures

At the age of 75, Joan Brennan was exhausted and constantly out of breath. These symptoms were particularly difficult for her as she was an avid hiker and loved spending time in her garden. “It was very difficult to walk without holding onto something,” says Joan. “I couldn’t even walk to the end of the block.”

Joan’s aortic stenosis, diagnosed in 2019, had progressed to stage III heart failure. In early 2022, Joan’s cardiologist recommended and referred her for an aortic valve replacement dr Michael RinaldiInterventional Cardiologist and Medical Director of the Structural Heart Program at Atrium Health Sanger Heart & Vascular Institute.

Living alone, Joan was concerned about planning her recovery should she require major surgery. Due to her age and condition, Rinaldi recommended a Transcatheter Aortic Valve Replacement (TAVR). This procedure enabled the surgical teamthat includes Rinaldi, a cardiac surgeon, to replace her aortic valve using a catheter-based approach instead of open-heart surgery.

The Heart Failure Team has been performing TAVI procedures for ten years. Joan’s procedure was Sanger Heart & Vascular Institute‘s 2,022 TAVR procedure.

Alocal stenosis touches the lives of many people, and our TAVR treatment can dramatically improve their survival valuation“, satYes Rinaldi.We have refined this therapy over time to make it something that is very safe and effective.”

TAVR has become the first-line therapy for patients with aortic stenosis, particularly those over 70 years of age. The procedure is associated with low mortality rates, stroke, bleeding, and kidney failure. In addition, most TAVI patients can return home the next day to complete their recovery, which is usually much quicker than surgical recovery.

“As patients get older, they don’t want to have major surgery and want to spend much of their lives recovering.” satYes Rinaldi.Faster recovery times mean we give patients more quality years. IIt’s gratifying when we can get them back to their families and get them productive again.”

Why it is needed

Aortic stenosis occurs when the valve that controls blood flow between the heart and the rest of the body thickened and calcifys. This condition tends to affect old patient, but it can also affect those who are in the middleold.

As the valve progressively narrows, so does the heart got to pump harder to push blood through an increasing smaller opening. This builds up pressure in the heart and lungs, making the patient short of breath. Within a few years, the disease can lead to heart failure.

Since aortic stenosis is a mechanical problem, vAlve Replacement is the only viable treatment. Historically, this was done through surgery.

“The problem is that many elderly patients are not healthy enough for open-heart surgerysays Rinaldi. “And most patients would like to avoid heart surgery if they can, because it’s a big commitment with a lot of risk and recovery time.”

During the procedure, the new flap is placed in a stent, which is inserted into the patient’s leg artery with a catheter. The heart failure team trackis the catheter movement through the patient’s circulatory system with X-ray cameras and locations it opposite the narrowed aortic valve. Once placed, the stent is expands and supports the new valve. Thus, the patient’s narrow flaps the structure to hold the stent in place.

TAVR is Beneficial for patients who do not qualify for cardiac surgery. But IT can Also help patients who could undergo heart surgery, but would likely have a higher mortality rate and spend much more time in the hospital. these patients take riskever getding their functionality back. Additionally, iit is an alternative procedure for younger, healthier patients who are good surgical candidates but who would like return to their lifestyle faster after valve change.

Highly rated program

“We’ve been the busiest TAVR center in the Carolinas since the valve became commercially available 10 years ago,” he says dr John FredrickHead of the Department of Cardiovascular Surgery at the Sanger Heart & Vascular Institute. “This is important because a large number of studies show that higher volumes lead to better quality and a lower risk of complications.”

Because of this experience tThe TAVR team was selected by Edward’s Biological Sciences Host a training course for providers from other regional heart valve replacement programs. During the course, providers learned how to improve the efficiency of TAVI procedures.

The Sanger Heart & Vascular Institute’s TAVR program deserves it 5-Star program US News & World Report rating, making it one of only three centers in the Carolinas to receive the designation. It also received a 3 star rating from the Society of Thoracic Surgeons/ American College of Cardiology Transcatheter Valve Therapy Registration. The TAVR program is one of only a few programs in the United States to have received the highest ratings from both organizations.

“We have improved patient care by bringing together several specialties that have been doing good work to work even more closely together than before,” says Rinaldi. “We see patients together and discuss them in a joint conference every week. As we review her history and imaging, we work together to identify the therapies that will work best for her.”

In addition to the team’s outstanding surgeons, cardiologists and imaging experts, Rinaldi is grateful to the nurses and experienced caregivers who take care of the details and safely guide TAVR patients through the process.

Safe and Coptimistic Care

Joan was able to enroll in one thanks to the Sanger Heart & Vascular Institute’s commitment to cutting-edge research clinical study for a novel aortic valve technology that is widely used in Europe. This new valve significant reduced Joan’s Risk of needing a permanent pacemakerrightthein return, helped reduce she fear evens. Plus, as a trial patient, she was glad to receive extra Tests and attention from medical staff.

Johanna noticed an immediate improvement after her intervention. actuallyhe could get up and walk without feeling faint or short of breath. She recovered at home and began cardiac rehabilitationilitation a few weeks later.

Joan, says the team at the Sanger Heart & Vascular Institute was friendly and thoughtful and took the time to answer their questions.

“They were very understanding of the challenges patients face, both medically and emotionally,” says Johanna. “It was so refreshing for me. I felt safe and confident at all times.”

After her recovery, Joan says she’s returned to “serious walking” and can get her heart rate up to 135 without pain or shortness of breath.

“It’s like old Joan is back,” she says.

The TAVR team is for now Investigation of the long-term durability of the technology and planning of the lifetime management of heart valve replacements.

“Our catheter valves have a minimum of 10 years of follow-up, requiring annual echocardiography,” says Rinaldi. “So, Over time we will have excellent data not only on the durability of the catheter valves but also on the surgical valves.”

“For patients like Joan who are in their 70s, the speedy recovery of TAVR procedures outweighs any issue of durability.” says Frederick.

TAVR is available at Atrium Health Carolinas Medical Center and Atrium Health Cabarrus. learn more about Cardiac care from the Sanger Heart & Vascular Institute.

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