Transcatheter Aortic Valve Replacement

Good Samaritan Hospital has been for a pioneer in a new treatment option called the transcatheter aortic valve replacement (TAVR). TAVR is used for aortic stenosis. Aortic stenosis is a progressive disease that affects the aortic valves of the heart and affects up to 1.5 million people in the United States. Approximately 250,000 of those people develop debilitating symptoms that can restrict normal day-to-day activities, such as walking short distances or climbing stairs. While usually these patients can benefit from surgery to replace their ailing valve, many people do not have the surgery because they are too frail for operations or put off surgery fearing the risks and slow recovery.

TAVR is a new approach that addressed the aortic stenosis without the major surgery but instead by placing a new valve using a catheter. A highly-skilled cardiologist will thread a catheter that has a balloon device and a collapsed replacement valve up an artery to the point where the replacement valve needs to be placed. The replacement valve is then placed inside the patient’s aortic valve. The TAVR procedure is usually most performed by running the catheter through the femoral artery in the leg, but sometimes the approach will be through a small incision between the ribs.

Open-heart surgery remains the gold standard for aortic valve replacement, but not all patients are candidates for open heart surgery. Transcatheter aortic valve replacement (TAVR) is a miraculous technology that can be used for patients who are not candidates for surgery who need treatment for aortic stenosis. Good Samaritan has been a pioneer in this procedure, which has just recently been approved by the U.S. Food and Drug Administration (FDA).

Aortic Valvuloplasty

Aortic valvuloplasties are sometimes performed when a buildup of calcium makes the aortic valve stiff. It is a procedure often performed on elderly patients or others for whom surgery is not an option. In these patients an aortic valvuloplasty can provide symptomatic relief and a greatly improved quality of life, and can also be performed as a preparation for an aortic valve replacement. Similar to angioplasty, a balloon catheter is threaded through an artery and into the aortic valve and then inflated to open the valve. Once the valve is opened the balloon is deflated and removed from the artery.

Patent Foramen Ovale (PFO) Closures

A patent foramen ovale (PFO) is a flap-like opening between the two upper chambers of the heart, known as the left and right atria. In the womb all babies have an opening and after birth the flaps normally close to form a solid wall called a septum between the chambers. If the PFO does not close, the defect remains open and can permit blood that is normally filtered by the lungs, to pass unfiltered into the left atrium and out to the body including to the brain. Research indicates that persons suffering from PFO may have an increased risk of stroke. PFOs do not present any symptoms and some people may not be aware that they have the defect.

Interventional cardiologists may recommend closing the PFO using cardiac catheterization to insert a plug in the opening. The procedure, just as with other types of cardiac catheterization, involves the insertion of a long flexible catheter tube in the femoral artery. This is guided by the cardiologist into the heart. PFO closures may also be performed in tandem during open heart surgery undertaken to repair some other heart defect.

Transcatheter Mitral Valve Repair

Mitral regurgitation (MR) is the most common type of heart valve insufficiency affecting nearly one in ten people aged 75 years and older – approximately four million people in the United States alone. MR is a progressive and life threatening condition that occurs with the leaflets of the mitral valve do not close completely, causing blood to flow backwards and leak into the left atrium of the heart during the cardiac cycle. To maintain an adequate forward flow of blood through the body, the heart compensates by increasing the size of the left ventricle, the main pumping chamber of the heart. This requires the heart to work harder, and may raise the risk of irregular heartbeats, stroke, and heart failure.

TVMR is a minimally invasive procedure that may be an option for patients with MR who are too sick for surgery. Unlike surgery, this procedure does not require opening the chest and temporarily stopping the heart. Doctors place a thin tube (catheter) through the skin into a large vein in the leg to reach the heart. A clip is then implanted onto the center of the mitral valve (the valve between the left atrium and left ventricle of the heart).

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