Rhode Island Hospital Performs Its First Non-Surgical Heart Valve Replacement For Patients With Diseased Heart Valves

Posted Monday, April 09, 2012

Rhode Island's first TAVR procedure. Left to right: Paul C Gordon, MD, Shirley Dexter, Frank W Sellke, MD, Chief of Cardiothoracic Surgery at Rhode Island Hospital

Known as transcatheter aortic valve replacement, TAVR replaces a narrowed or diseased aortic heart valve non-surgically through a catheter that is inserted through the thigh. The valve is fed through that catheter to the heart, in effect, replacing the valve from the inside.

“This is a wonderful option for patients who are not well enough to endure open heart surgery,” said Barry Sharaf, M.D., interventional cardiologist and director of the cardiac catheterization lab at Rhode Island Hospital “Through TAVR, patients will be able to return to doing the things that most people take for granted – such as walking or climbing a flight of stairs.”

Previously, patients who could not undergo open heart surgery would be treated with maintenance medications, but would not have the diseased valve surgically repaired or replaced. TAVR is performed in an operating room by an interventional cardiologist with support from a multi-disciplinary team, including cardiothoracic surgery staff.

“TAVR is proving to be a very beneficial treatment for patients who are unable to withstand open heart surgery, and helps to significantly improve their quality of life,” said James Fingleton, M.D., cardiothoracic surgeon at Rhode Island and The Miriam hospitals. “This procedure is truly a team effort – while it is a  less-invasive, non-surgical procedure, it requires the participation of many teams to ensure the best outcome.”

There were 30 clinical staff members in the OR during the procedure, including cardiology, interventional cardiology, cardiac surgery, vascular surgery, anesthesiology, cardiac perfusion, as well as clinical support staff from the cardiac catheterization lab and operating room and was a joint effort between Rhode Island and The Miriam hospitals, as well as the Cardiovascular Institute at both hospitals.

Aortic stenosis is a progressive disease that affects approximately 1.5 million people in the United States. About 250,000 of these patients suffer from severe aortic stenosis, which can restrict normal day-to-day activities, such as walking short distances or climbing stairs. Heart valve disease can occur in any single valve or a combination of the four valves, but diseases of the aortic and mitral valves are the most common, affecting more than 5 percent of the population.

Without valve replacement, severe aortic stenosis can be life-threatening; 50 percent of patients will not survive more than an average of two years after the onset of symptoms.

The procedure uses the Edwards Sapien Valve, which was approved by the U.S. Food and Drug Administration in November 2011. It is the first valve replacement therapy performed using a catheter approved for use in the U.S. The TAVR procedure enables the placement of a collapsible aortic heart valve into the body via the femoral artery in the thigh. The valve is designed to replace a patient’s diseased aortic valve without traditional open-heart surgery and while the heart continues to beat, precluding the need for cardiopulmonary bypass. Severe aortic stenosis usually occurs in patients older than 75.

Rhode Island and The Miriam hospitals opened a combined open heart surgery program in October 2011. The new program consolidates open heart surgeries from both hospitals onto the Rhode Island Hospital campus, while maintaining a robust and comprehensive cardiac services program on The Miriam Hospital campus, including cardiac diagnostic testing, such as cardiac catheterization and coronary intervention (angioplasty and stenting), cardiac rehabilitation and prevention.

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