Transcatheter Aortic Valve Replacement (TAVR) Program
Aortic stenosis (narrowing) is a potentially life-threatening condition. The aorta is the main artery carrying blood from the heart to the rest of the body. When blood leaves the heart, it flows through the aortic valve, into the aorta. In aortic stenosis, the aortic valve does not open fully. This condition decreases blood flow from the heart. In patients in whom the stenosis progresses and becomes severe, the result is a life-threatening condition. Aortic stenosis is one of the common aortic valve problems, along with aortic regurgitation (leakage), that we treat in different ways at the Valve Center. The 2011 FDA approval of the Edwards SAPIEN aortic valve replacement device, which can be passed "over a wire" into the heart without major "open heart" surgery, represents a breathtaking advance in the way heart surgery is performed to treat aortic stenosis. It is the first artificial aortic heart valve placed without open heart surgery.
What Is the Transcatheter Aortic Valve Replacement (TAVR) Program?
The Stony Brook Valve Center offers new hope for high-risk patients with severe symptomatic aortic stenosis in need of valve replacement surgery. Without valve replacement, studies indicate that more than half of all patients with severe aortic stenosis will not survive an average of two years. Unfortunately, many of these patients are too ill to undergo open valve replacement surgery, still considered the gold standard treatment.
But now there's a new, less invasive approach — and with it, hope — even for patients with significant other medical issues. Stony Brook University Hospital is one of a select number of sites in the United States to offer the new minimally invasive procedure called transcatheter aortic valve replacement (TAVR) or implantation (TAVI) that uses the Edwards SAPIEN transcatheter heart valve.
The Edwards SAPIEN heart valve (top right) is placed by means of a wire inside the catheter (flexible thin tube) inserted in the groin and threaded up to the heart through the patient's arteries; see illustrated description of TAVR procedure.
This innovative procedure delivers a replacement valve via catheter while the heart is still beating. Clinical trial data is promising: The two-year, all-cause mortality rate is 43% compared with 68% for patients treated medically. Recovery time averages from one to two weeks.
Patient selection and follow-up care involve a collaborative effort between referring physicians and our valve specialists.
Stony Brook's TAVR program is leading the way in the new era in heart surgery, where valve surgery can be performed without the surgery. Our multidisciplinary team of physicians includes two heart surgeons and four cardiologists — all with special expertise in valve disease and treating aortic stenosis (click on the Our Team tab above).
Our program is patient-focused in every aspect, from patient selection to procedure planning to treatment and postoperative care. Indeed, the care provided at the Valve Center is distinguished by our team approach, together with easy access to our valve specialists and excellent communication with referring physicians. In most cases, patients are seen at the Valve Center within one week of referral.
Our TAVR team will soon be performing the valve replacement procedure using the transapical approach as an alternative option to the transfemoral approach. Use of the two different TAVR techniques will allow for more patients to be candidates for the life-saving procedure, as one may be feasible when the other is not. During the transapical approach, a small incision is made between the ribs of the left lower chest, and the replacement valve is then inserted directly into the heart. During the transfemoral approach, the replacement valve is inserted into the femoral artery through a small incision in the groin, and is then guided into the heart.
If you are a patient with severe aortic stenosis, or if you are a physician caring for a patient with this condition who could benefit from further evaluation, please call 631-638-2101 to make an appointment, or to obtain more information about our TAVR program.
Our multidisciplinary TAVR team has years of training and experience in cardiology including interventional cardiology and in cardiothoracic surgery including valve surgery. This enables us to use the TAVR technology effectively in treating aortic stenosis and to provide comprehensive care for patients.
Harold A. Fernandez, MD |
Luis Gruberg, MD |
Allen Jeremias, MD |
Smadar Kort, MD |
James R. Taylor Jr., MD |
Jonathan B. Weinstein, DO |
Questions about TAVR:
- How may TAVR procedures have been performed?
- When was TAVR approved?
- Does Medicare/Medicaid cover TAVR?
- What are the risks with the TAVR procedure?
- How long does the TAVR procedure take?
- How long does it take to recover after having the procedure?
Q: How may TAVR procedures have been performed?
A: As of February 2012, more than 25,000 patients have been treated with the TAVR procedure by multidisciplinary heart teams worldwide.
Q: When was TAVR approved?
A: In November 2011, the U.S. Food and Drug Administration (FDA) approved the Edwards SAPIEN aortic valve replacement device for use in treating patients with severe native aortic valve stenosis who have been determined by a cardiac surgeon to be inoperable for open (conventional surgery) aortic valve replacement, and in whom co-existing illnesses would not preclude the expected benefit from correction of the aortic stenosis.
Q: Does Medicare/Medicaid cover TAVR?
A: Yes, the Centers for Medicare and Medicaid Services approved the TAVR procedure for coverage on May 1, 2012.
Q: What are the risks with the TAVR procedure?
A: There are still risks associated with TAVR, as with surgical aortic valve replacement. These risks should be taken into consideration when discussing the TAVR procedure with your cardiologist.
Q: How long does the TAVR procedure take?
A: The average time required to perform the procedure is 4 to 5 hours.
Q: How long does it take to recover after having the procedure?
A: Recovery time averages from one to two weeks.
The TAVR procedure is performed in the hospital, with the patient asleep under general anesthesia. It generally takes about 4 to 5 hours. This animation of the procedure shows how the artificial aortic valve is placed by means of a catheter (flexible thin tube) from within the arteries to the heart itself, to treat the aortic stenosis.
Contact:
Stony Brook Valve Center
Stony Brook Heart Institute
Nicolls Road and Health
Sciences Drive intersection
Stony Brook, NY 11794
Phone: (631) 638-2101
