Low energy. Feeling very tired or sleepy all the time. Getting short of breath just walking to the mailbox. This is what life is like for anyone suffering from valve disease.
Fortunately, these patients now have access to a minimally invasive procedure offered at McLeod Regional Medical Center that restores their quality of life.
Since 2017, the McLeod Valve Clinic Team has replaced diseased heart valves using the transcatheter aortic valve replacement (TAVR) procedure for more than 145 patients. These team members include cardiothoracic surgeons Cary Huber and Robert Messier; interventional cardiologists Fred Krainin and Brian Blaker; anesthesiologists Daniel Fox, Robert Savage and Robert R. Casella; and nurse practitioner Ryan Hill, the valve clinic coordinator.
Patients often learn about TAVR after complaining of great fatigue during a visit to their primary care physician. This fatigue accompanies shortness of breath, particularly when exerting themselves. The fatigue and shortness of breath make everyday tasks difficult to manage. Other symptoms patients might experience include chest pain, fainting or an overall feeling of weakness.
Patients with these typical valve disease symptoms are often referred to the McLeod Valve Clinic, where a team of specialists meet with the patient and family to discuss the clinic process. Hill then helps arrange the patient’s required testing, which includes a cardiac catheterization, lung screening, CT scan, carotid ultrasound and lab work.
Once results are available, the valve clinic team reviews the findings to determine the best treatment plan for the patient.
One aspect of the program that the team must determine involves who meets the guidelines for the TAVR procedure. When we first began the program, only patients considered high-risk for surgery received a TAVR valve. However, the U.S. Food and Drug Administration changed the requirements so low-risk patients can also be considered as candidates. Low-risk heart valve disease patients who do not need any additional heart surgery are now evaluated for the TAVR procedure.
TAVR is performed similar to a heart catheterization. During the minimally invasive procedure, the physician inserts a catheter, a long flexible thin tube with the artificial valve, through a small incision in an artery in the leg. The physician then guides the catheter to the heart using X-ray imaging. Once exactly positioned across the diseased valve, the new valve is released and starts working immediately. The old valve provides the foundation to hold the new valve in place.
The majority of TAVR procedures are performed through an artery in the groin; however, physicians can also access the site through the artery in the neck. This alternate access site ensures the eligibility of even more patients, especially those with peripheral arterial disease, blockages in the arteries of the lower limbs.
McLeod vascular surgeons who specialize in operating on the veins and arteries in the body assist the valve team with access of the carotid artery. These vascular surgeons, Eva Rzucidlo, Carmen Piccolo, William Jackson and Gabor Winkler, participate in the TAVR procedure whenever called upon.
Until now, valves were replaced with open heart surgery, which has been available since the 1960s. This invasive procedure requires opening the chest and placing the patient on the heart-lung machine to repair or replace the valve. With the introduction of the minimally invasive TAVR procedure, patients spend fewer days in the hospital and return to their normal activities much quicker.
TAVR procedures emphasize a team effort. We could not do this without the physicians and staff working together for the benefit of the patient. As a group, we identify the patient, then plan and perform the TAVR procedure. All of our members bring to the team their experience and expertise for the best care of the patient.