VA Sierra Pacific Network (VISN 21)

An estimated 300,000 Americans are diagnosed each year with severe aortic stenosis, a condition where the aortic valve doesn’t open fully, decreasing blood flow from the heart to the body. Thanks to TAVR, many of those patients who are too high risk for traditional open-heart surgery now have an option for treatment.

On November 25, 2013, a multi-disciplinary heart team at the San Francisco VA Medical Center (SFVAMC) successfully performed its first two transcatheter aortic valve replacements (TAVR) for two Veteran patients who needed, but who were high risk for, open-heart surgery.

One year and three months later, the team continues to successfully perform TAVR procedures for patients who are not candidates for traditional cardiothoracic surgery. “We have now performed TAVR on 41 patients with excellent results,” says Chief of Interventional Cardiology Kendrick Shunk, MD. “We have certainly saved some lives.”

An estimated 300,000 Americans are diagnosed each year with severe aortic stenosis, a condition where the aortic valve doesn’t open fully, decreasing blood flow from the heart to the body. Without treatment, approximately half of the people who have systematic aortic stenosis die within an average of two years after symptoms begin.

Traditional surgery involves replacing the aortic valve through open-heart surgery, requiring a large incision through the chest. For many patients and the elderly or frail, the traditional surgery is too high-risk, and they wouldn’t survive. That’s why TAVR surgery is so important. It can save the lives of those who would otherwise have no other treatment options.

TAVR is less invasive (the entry point is a small incision in the leg), and cardiopulmonary bypass is usually not needed.

“This procedure is as good as traditional surgery and recovery is much faster. Hospitalization averages only 2-4 days after the procedure and then usually the patient can go home,” says Dr. Shunk. “Traditional cardiothoracic surgery requires an average 10-day hospital stay, and patients typically transfer from there to a skilled nursing facility for further recovery.”

“Patients are very happy with the procedure,” says TAVR Coordinator Julia E. Leone Hecker, NP. “They get to skip the opening of the chest, there’s less pain, and they go home sooner. In some cases we use conscious sedation, and avoid general anesthesia. It’s exciting to be able offer this minimalist approach to critically ill patients, who may have not tolerated general anesthesia very well.”

Nurse Hecker added that there are several valve sizes now available, allowing the team to treat more Veterans without using more invasive, surgical approaches. “Thankfully for FDA approval, we now have 3 sizes of Edwards Sapien XT valves and 4 sizes of Medtronic CoreValves, so most patients have a matching valve. The valve is delivered through the leg, so now that the devices are much smaller, we’re able to treat more Veterans more quickly, with less risk. It’s pretty awesome.”

“Our TAVR patients recover quickly and are back in their gardens, or spending time with family,” says Nurse Hecker. “I think the value of the trans-aortic valve is that it is not hard on the patient, and they are getting great symptom relief. They wake up in 4 hours and they feel better, and are not in pain usually associated with traditional cardiothoracic surgery.”

Veteran Philip Hanley, former US Army Special Forces, age 78, is SFVAMC’s second TAVR patient. “Prior to the TAVR surgery, I had no endurance and I used to get out of breath,” says Philip. “Now I feel really well and have a lot more energy than I did before. I can do everything I have to do.”

“As soon as the incision closed up, I was able to go home,” says Philip. “It was amazing. Dr. Shunk is my hero. I have nothing but accolades for Dr. Shunk and his team.”

Besides a faster recovery, other benefits of TAVR vs. standard heart surgery is that within one year after the procedure, patients decrease their repeated hospitalizations by half, fewer need a new pacemaker, fewer have kidney failure, and far fewer need additional procedures on the operated valve, according to data supplied by Edwards Lifesciences Corp., the company that makes some of the transcatheter aortic valves used in TAVR surgeries.

Not everyone is a good candidate for traditional heart surgery or TAVR and, as with any surgical procedure, there are risks. For more information about TAVR surgery at SFVAMC, contact TAVR Clinical Coordinator Julia E. Leone Hecker, NP, at (415) 221-4810, ext. 3243.