Transcatheter Aortic Valve Replacement

Intro: This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here’s Deborah Howell.

Deborah Howell (Host): Welcome to the show. I’m Deborah Howell, and today we’ll ask the question: what is TAVR and how might it save your life? Our guest today is Dr. Sanjiv Patel, an interventional cardiologist at Orange Coast Medical Center. Welcome, Dr. Patel.

Sanjiv Patel, MD: Hi, good morning.

Deborah Howell (Host): My first question is pretty obvious: what is a Transcatheter Aortic Valve Replacement, or TAVR, and how is the procedure performed?

Sanjiv Patel, MD: TAVR, the Transcatheter Aortic Valve Replacement, is a minimally invasive procedure done to open up a narrow aortic valve percutaneously through the groin. So this procedure is kind of an improvement on the traditional surgery that is done to replace the aortic valve, and is performed mainly through the groin of the patients. And we put a catheter with the valve mounted on top of it, which is crimped on it, and we put it inside the body and basically put it across the narrowed, tight aortic valve and inflate it with a balloon. And with the new valve in place, patients should feel much better.

Deborah Howell (Host): Now, are you talking about both men and women when you say going up through the groin?

Sanjiv Patel, MD: Yes, for any gender, yes. Male or female, it doesn't matter.

Deborah Howell (Host): Got it. Who might qualify as a candidate for TAVR, and are there some new guidelines as to who qualifies?

Sanjiv Patel, MD: Yeah, so for the Transcatheter Aortic Valve Replacement procedure, people who qualify are people who have a severe aortic stenosis with symptoms. And with the recent update in the summertime, which is a great trial that came out, which basically supports this procedure in people with any kind of risk for complications for traditional valve surgery. So they can be a high risk, low risk, or intermediate risk for traditional valve surgical complications; they can all qualify for a TAVR. And for that to happen, the patient needs to be evaluated by a team of experts before they can proceed with this kind of procedure.

Deborah Howell (Host): Sure. Well, that’s pretty much with any procedure. And what are some common symptoms of aortic stenosis that people should be aware of and get checked out by a physician?

Sanjiv Patel, MD: Interesting, Deborah. For this aortic valve stenosis, a lot of people have it, a lot of people are asymptomatic. But the most common symptoms that happen with this valve is difficulty breathing, they may have fatigue and tiredness that is happening over slowly over time, which sometimes can be missed by patients as they feel this is old age, but really this is a valve. They can feel dizziness, have chest pain, and they can even pass out from this valve being so narrowed.

Deborah Howell (Host): Interesting. So at what age when you say "old age"?

Sanjiv Patel, MD: People think they're old when they're in their 60s, 70s, and 80s. But technically, old age is just a term used by people, not necessarily labeling anybody else.

Deborah Howell (Host): Oh, that’s very interesting. Okay. And so, how would you say approximately much of the population is affected by aortic stenosis?

Sanjiv Patel, MD: So, about half a million people in the U.S. have severe aortic stenosis, and of those, about 250,000 people are symptomatic from it. And the most interesting thing is, of those people who are symptomatic, not all of them get evaluations for this kind of procedure or any kind of procedure. So it’s interesting, of 250,000 people who have the symptomatic aortic stenosis, only about 88 to 90,000 people get surgery, actually. And even then, only 18 to 20,000 people are getting TAVR. So there is a great need for awareness among patients and among physicians.

Deborah Howell (Host): Why do you think that is?

Sanjiv Patel, MD: I think a lot of patients feel they're okay, and since this disease is mostly occurring in elderly populations, in 60, 70, 80, 90-year-old age groups, a lot of people think this is they're just aging and feeling tired and fatigued and not realizing that this may not be the reason only, and therefore they don't seek care from the primary care physician. And when they seek care for the primary care physician, they don't tell them that they are having these issues, so they just get monitored.

Deborah Howell (Host): So, pay attention to your symptoms if you’re, you know, in your 60s, 70s, 80s. Maybe it’s not just age; maybe it is something that is fixable with TAVR. So, what are the benefits to this minimally invasive approach compared to a traditional valve replacement, and also what’s the expected recovery time after the procedure?

Sanjiv Patel, MD: Right, so once you are deemed that you need to have something done about your aortic valve procedure, the minimally invasive procedure, the TAVR, T-A-V-R, compared to traditional surgery where they open your chest and repair the valve - or replace the valve, I should say - the newer procedure tends to have quicker recovery time, less rehospitalization after the procedure, as well as lower stroke risk for the patient. So they tend to do much better in this newer procedure. In terms of recovering from this procedure, since it's minimally invasive, we're going mostly from the groins, recovery tends to be one week to two weeks at most, and even then, people are walking the next day, the day of, actually, and the next day, and they go home, most of them, the day after. And they're actually walking and doing their activities at home, but not necessarily exercising for one or two weeks until the entry point to the body is healed, after which they can resume their daily activities in terms of exercising and, you know, running, lifting, all that kind of stuff that they like to do, which is great.

Deborah Howell (Host): That's totally amazing. What about driving, is it usually a couple weeks?

Sanjiv Patel, MD: Yeah, driving, because we go from the groin, usually one to two weeks we try to not have them drive, just to make sure there's no bleeding complication that can happen, so...

Deborah Howell (Host): Okay, that’s all the good stuff. Now, what are some of the potential risks associated with this procedure to consider?

Sanjiv Patel, MD: So the risk of any procedure, of any surgery, is mortality, right? Death of having a procedure. It is very little, very low risk. If you - if your risk of pre-procedure complication is low risk, your chance of mortality from this procedure is less than 1%, which is pretty low. The other complications, which can be damage to the vessels where we go from the groin, other is low risk of stroke, which is at 1% in a very low-risk population. More importantly, with the TAVR, we worry about a pacemaker rate of implantation. Pacemaker is a permanent pacing device that we have to implant in a person who gets the valve and their heartbeats are so slow and they may need that help to help increase the heart rate. So that can be a potential complication that you worry about after having the TAVR procedure. Not that even the regular surgery can't have that risk, but it will be more common, about 5 to 6% depending on even 7% depending on the risk of people may need to get a pacemaker, permanent pacemaker, after getting TAVR valve done.

Deborah Howell (Host): And how will the new aortic valve function after the procedure?

Sanjiv Patel, MD: Once we implant the valve itself, we usually check the valve function immediately while patient in the room, to make sure the valve is appropriately placed and the function of opening and closing the valve is appropriate. We also look for any kind of abnormal leakage from the valve. So all that stuff gets done right off quickly, immediately for the procedure, and usually this valve tends to do very well in terms of function right after the procedure. But they do need to have an ultrasound done a month later, and then a year later, to make sure that they are still functioning well. Up until now, the longevity of the valve, we know it's about seven years to eight years for now; we don't have any more data than that for now, so, which is pretty good.

Deborah Howell (Host): That's very good, and then they have to just replace it again?

Sanjiv Patel, MD: Let's say in the future if they get a narrowed valve again, the option is, if depending on the risk of the person at that time, they can get repeat TAVR again, or if they're still low risk, they can choose to have an operation, it's a possibility as well. But most of the time they will get repeat TAVR procedure.

Deborah Howell (Host): Sure, rather than go through the non-minimally invasive procedure, for sure. I have a final question for you, Dr. Patel: what heart-healthy recommendations do you typically provide to patients post-surgery?

Sanjiv Patel, MD: The heart healthy recommendation would be like anybody else. So, you know, obviously because the procedure is done recently, you got to be a little bit more careful for one or two weeks or three weeks maybe even, but after that basically still be should be doing four pillars of your life, which is eating better, exercising, sleeping well, and controlling your risk of cholesterol problem or high blood pressure or diabetes, sleep apnea; all these things has to be controlled. And eating better I meant was, you know, low fat, low cholesterol, more fruits, vegetable kind of diet. And in terms of exercise, they should be doing 30 to 40 minutes a day of, you know, any kind of aerobic exercise like treadmill or step masters, and mixing it with some kind of a low weight repetition weightlifting few times a week. So this combination will help them feel better and increase their longevity.

Deborah Howell (Host): Thank you so much, Dr. Patel, for your time today. We really, really appreciate you being with us.

Sanjiv Patel, MD: Thank you.

Deborah Howell (Host): And for more info or to listen to a podcast of this show, please go to memorialcare.org or call 844-934-TAVR. That’s 844-934-8287. That’s all for this time. I’m Deborah Howell. Thanks for listening and have yourself a terrific day.