To Your Health: TAVR procedure offers valve relief for high-risk patients

By Alfred Casale - To Your Health
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I’m writing this on Sunday evening in Chicago after visiting with my granddaughters Rowan, 28 months old, and Eve, now just 10 weeks old. It’s been a true delight spending time with them and seeing how beautifully my daughter, Kate, and her husband, Andy, are doing raising these wonderful kids.

My darling wife, Mary, has been spending lots of time with them helping out and her amazingly positive influence is evident in the kindness, gentleness, fun and imagination that Ro demonstrates.

Although Rowan calls me “Doc,” we’re not at all sure she realizes that I’m actually a doctor since it’s clear to her that the only people qualified to fix “boo-boos” and “ouchies” are Kate and Mary.

One of the best Christmas gifts she got was a toy tool bench with a variety of quite realistic, safe, plastic tools. She loves using them as Dr. Rowan and her assistant, Dr. Mary, to give “checkups” to her friends, Lambie and Cupcake (a bear whose nose looks like a big cupcake.)

It’s a little off-putting to see her use a screwdriver to examine ears, but nowhere near as scary as when she approaches with the battery-operated toy electric drill saying “Open wide!”

Today, though, I saw a real innovation — the “heart hammer.” It seems Lambie’s heart was not right, but a firm yet gentle tap with the heart hammer set all things right. Who knew? When I get home I’m ordering one for each of the cardiac surgery ORs I’m responsible for.

The hammer may be a good compliment to another really amazing technique we’ve offered locally for about five years. First, as one of a few dozen sites testing the method and now as a leading center, we’ve been replacing narrowed aortic heart valves not with open heart operations, but with a less invasive procedure using catheters placed through the groin artery.

The aortic valve is a delicate but strong structure between the heart and the rest of the circulatory system that serves to keep blood flowing forward and preventing backflow. It opens with each heart beat and closes as the heart refills to pump again. At least 37 million times a year, the three leaflets of the valve open and close. Sometimes, especially as we age, the leaflets, normally as tough as your ear but as thin as a blister, thicken, harden and stick together in a way that narrows the opening through which blood flows. This forces the heart muscle to work extra hard to push blood through a hole the size of a pencil instead of the normal opening, about the diameter of a quarter. We call this disease process aortic stenosis.

One of the triumphs of modern medicine has been the ability to replace narrowed, stenotic aortic valves with artificial valves made of either man-made or natural materials. These open heart operations are miraculously effective in relieving the heart of the worrisome extra workload from squeezing blood through openings much too narrow. But the price we pay for this relief is the stress of anesthesia, an operation to open the breast bone and expose the heart, and the use of a heart-lung machine to temporarily take over the heart’s work as the valve is replaced. Although still the standard way of dealing with aortic stenosis for most patients, some are too sick to tolerate the stresses involved without having the risks outweigh the benefits.

For these particular high-risk patients, a new technique allows us to fold the new valve into a compact shape about the size of a pen, guide it through the bloodstream using wires placed through the groin artery and expand the valve into place within the old valve, pushing the thickened leaflets out of the way and against the sides of the aorta. This “TAVR” or “TAVI,” that is transcatheter aortic valve replacement or insertion procedure, offers relief of the obstruction in patients not otherwise up to an operation, with quite low risks when experienced teams evaluate them carefully, prepare patients thoroughly, and perform the procedure skillfully.

We’re fortunate that in our region this technique is available for appropriate patients at facilities with teams that have been at the forefront of the field since it began. Ask your doctor if you need more information.

I’ll let you know more about the “heart hammer” as I learn it.

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By Alfred Casale

To Your Health

Dr. Alfred Casale, a cardiothoracic surgeon, is Associate Chief Medical Officer for Geisinger Health and Chair of the Geisinger Cardiac Institute. Readers may write to him via [email protected]

Dr. Alfred Casale, a cardiothoracic surgeon, is Associate Chief Medical Officer for Geisinger Health and Chair of the Geisinger Cardiac Institute. Readers may write to him via [email protected]