TAVR is used for high-risk aortic stenosis patients. Why not everyone?

As recently as 15 years ago, if you had severe aortic stenosis but were considered too ill or weak to survive surgery, there was little else we could do for you. Since then, transcatheter aortic valve replacement (TAVR) has come on the scene as a less-invasive option to traditional open heart surgery.

This has been a game-changer for many people. Because it’s so new, not every facility offers this procedure. We have treated more than 1,300 patients with TAVR, and many of them travel here because they can’t get it closer to home or are interested in a less-invasive option.

TAVR currently is approved for patients with severe aortic stenosis who are at intermediate or high risk of complications during surgery, in addition to surgically inoperable patients. We have launched a clinical trial in 2016 to study the procedure’s safety and effectiveness in a wider range of patients. TAVR may become the new standard of care for more patients with this serious heart condition.

In the meantime, learn how TAVR works and whether you or a loved one might be a candidate for this procedure.

What is aortic valve stenosis and how is it treated?

Aortic stenosis occurs when the heart’s aortic valve doesn’t open fully, preventing blood from flowing freely into the rest of the body. This causes the heart to have to work harder and eventually weakens the heart muscle.

Aortic stenosis is a progressive disease, and as it worsens, symptoms may include:

  • Abnormal heartbeat (known as a heart murmur)
  • Chest pain
  • Dizziness or fainting
  • Fatigue
  • Shortness of breath
  • Sudden death

These symptoms can affect your daily life in many ways, from making it difficult to walk to the mailbox to adding stress from worrying about your health.

In the early stages of aortic stenosis, you may not need treatment. In that case, we’ll monitor the condition to ensure it’s not getting worse. Medications can ease symptoms, but will not fix the problem. The only way to do that is through surgery.

In a traditional aortic valve replacement, the surgeon makes a large incision in the chest, cracks the breastbone to reach the heart, removes the damaged valve and replaces it with a new one. This surgery typically requires a five-day hospital stay and four-week recovery.

TAVR doesn’t require a large chest incision or broken bones – making the recovery time much shorter.

How does TAVR work?

TAVR ProcedureIn transcatheter aortic valve replacement, the doctor inserts a catheter into an artery through a small incision in your groin or chest. At the end of the catheter is a deflated balloon with an artificial valve wrapped around it. The doctor guides the catheter through the artery to the aortic valve, at which point the balloon is inflated and the new valve expands, pushing the damaged valve out of the way. The doctor then deflates the balloon and removes the catheter.

This procedure typically requires a three- to five-day hospital stay. But because no bones need healing, most patients can resume normal activities soon after.

All surgical procedures carry risk. But a 2016 study showed that patients at intermediate risk for complications during surgery who received TAVR had slightly lower rates for death and stroke as those who had had a traditional aortic valve replacement. And for patients whose TAVR was done through the femoral artery in the groin, the rate was even lower.

Though TAVR is less invasive than traditional surgery, it’s not yet approved for all patients with severe aortic stenosis.

Who is a candidate for TAVR?

TAVR currently is approved by the Food and Drug Administration (FDA) for people with severe aortic stenosis who are at high or intermediate risk of complications during open heart surgery. These patients often are older or have other medical conditions that make surgery more dangerous.

Even then, not every patient who fits these criteria is a candidate for TAVR. You may have anatomical features or other conditions that may not make this procedure the best option. For example, if there’s significant disease in multiple arteries, you’d likely benefit from more than just valve replacement, in which case open surgery likely would be required.

One reason TAVR is currently restricted to patients at higher risk is that it’s a pretty new procedure, so we don’t have established data for how it compares over the long term to traditional surgery. One of the questions up in the air surrounds the durability of the valves used in TAVR. Valves used in a traditional surgical replacement last 10 to 15 years. We’ve only been performing TAVR for about a decade, so we don’t have long-term data on these devices yet.

For patients at high or intermediate risk during surgery, TAVR is quickly becoming the standard of care for severe aortic stenosis. The purpose of the latest studies is to determine whether TAVR is equal or superior to surgery for low-risk patients. Our trial will evaluate the safety and efficacy of the procedure in these patients.

TAVR is an exciting development in the treatment of aortic stenosis, and we’re hopeful that our study will help demonstrate that less-invasive procedures are safe and effective for as many patients as possible.

On a New Mission

Leading up to this summer's opening of the Nancy and Harold Zirkin Heart & Vascular Hospital at MedStar Washington Hospital Center, we will be sharing a series of stories that provide a glimpse into the lives of some of our heart and vascular patients, the care they received and what life has been like for them since being treated. Today we visit with retired Navy Admiral, Tim Heely. 

An Unexpected Trip To The Hospital

Tim Heely, a retired Navy Admiral and F-18 pilot, has always been very active and diligent about his health. One night, after his daily run of about 5 miles, Tim started to experience pain in his arm and had difficulty catching his breath. True to his nature as a navy pilot, Tim was predisposed to not go to the doctor and decided to wait it out. He thought he merely had a case of pneumonia and never expected to eventually need a heart transplant.

Eventually, Tim’s wife convinced him to see a doctor, and they went to MedStar St. Mary’s hospital close to their home in Southern Maryland. Within minutes, Tim was being sent to MedStar Washington Hospital Center in D.C. Once they arrived, Tim had a couple of stents implanted by the time his wife was able to park the car and enter the building.

Tim had had a heart attack that did so much damage, his heart was unable to sustain itself. Tim says, “I like to think that when I went in [St. Mary’s] they knew exactly where to send me and who to call. There’s strength in having that tie.”

New Wingmen, A New Heart

Tim explains, “As a navy pilot, I took risks every day and loved it. I learned to trust my training, my aircraft and my wingmen.”

Throughout the course of 5 days, Tim put his full trust in the heart and vascular team at MedStar Washington as they worked diligently to stabilize his heart. Unfortunately, Tim’s body rejected each treatment attempt. It was then decided that a Left Ventricular Assist Device (LVAD) would be the best option while he waited for a new heart.

Tim received the LVAD on May 17th, 2011 and enjoyed good health for 2 years, until a complication meant that it was time for a heart transplant.

On May 7th, 2013, Tim received a new heart.

“Thanks to the doctors and the nurses I’m back alive and I shouldn’t be,” Tim recounts. He remembers one specific instance during the beginning of his care when his body was rejecting multiple treatments. One resident was really putting in the extra effort. She noticed something was wrong, made phone calls and spent a lot of time trying to figure out what was going on.

When Tim received his heart transplant, he recognized the voice of one of his doctors, the same resident that had put so much attention to his care nearly 3 years before. Tim expressed his gratitude, “There's like 3-5 times where someone really made a difference, and if they weren’t there I would have been dead, this was one of those times.”

Transplant Triathlons

Although Tim decided not to return to work due to a stressful commute, he has started his own company and is also taking part in his own self-run transplant triathlons. He walks, kayaks and bikes multiple miles a day. “I feel really good. I want to be the guy that didn’t let this get him down. I wanna be the guy where people say ‘can you believe what this guy did?’ ”

Since that day, Tim has seen all of his children marry, and he now has 2 grandsons. “I’m very grateful and I feel in a lot of ways better than I felt before because I’ve died and come back and everything means a little bit more to me. Every day I wake up and I thank my donor and the donor’s family.”

Tim has also served as a mentor for other patients receiving care at the MedStar Washington Heart and Vascular Institute, “I’ve mentored about 6 people on getting the LVAD or getting a heart transplant. I like telling them that there is hope.”

Tim shares that getting a heart transplant “...was a very good learning experience on so many levels. Everyone has a problem and you may just not know it. None of us is perfect, we all have something.”

Have any questions?

We are here to help! Contact us for more information about heart transplants or to schedule an appointment. Call us at 202-877-3627.

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Building a Future

Leading up to this summer's opening of the Nancy and Harold Zirkin Heart & Vascular Hospital at MedStar Washington Hospital Center, we will be sharing a series of stories that provide a glimpse into the lives of some of our heart and vascular patients, the care they received and what life has been like for them since being treated. Today, we visit with Alberto Gomez. 

Advanced Heart Failure Takes its Toll

Alberto Gomez is the owner of a Washington, D.C.-based construction company who has always enjoyed good health, and who has rarely spent much time with doctors aside from yearly physical examinations.

However, noticeable fatigue and discomfort led him to seek care at MedStar Washington Hospital Center. At the age of 66, Alberto was diagnosed with advanced heart failure. He was given the sobering news that his heart was functioning at an estimated 15%, and that he would need a heart transplant in order to survive.

“It was a very sobering experience to come from not having seen doctors in a long time to seeing them every day, to every 5 minutes, to every 15 minutes,” shares Alberto.

A Second Chance

After meeting with Dr. Ezequiel Molina, a cardiac surgeon at MedStar Washington Hospital Center, Alberto learned that he was a candidate for a new technology called Left Ventricular Assist Device or LVAD, a device that is implanted into the chest that supports the pumping function of the heart. This would be his lifeline until he was able to receive a heart transplant.

After receiving the LVAD, Mr. Gomez suffered complications, such as strokes, that left him with limited movement and speech impairments. Throughout this process, he received a lot of therapy and encouragement from his team at MedStar, “and the smiles,” says Alberto. “I tell a lot of jokes so I can laugh when people laugh, and I can enjoy them when they enjoy them.”

Alberto’s willingness to work in conjunction with the doctors, as well as the holistic approach to care that Alberto received from the team at MedStar, made a huge impact on his recovery process. He shares that, “the support one receives from the professional staff, the administrative staff, the nurses, and everyone around, they create the environment for recovering much faster than it would normally take.”

A New Heart

On November 9, 2014, Alberto received a call from Jessica Rice, a heart transplant coordinator at MedStar Washington Hospital Center, letting him know that a matching heart had been found.

On December 10, 2014, the same influential team at the Hospital Center that worked with Alberto to diagnose and treat his advanced heart failure with the LVAD device, helped implant his new heart. Continuing his care with the same team was paramount in his process. “They knew what was inside, they knew what they had to take out, and now they knew how they were going to transplant the new organ in,” says Alberto. “My doctors were not just my doctors. They were my friends, they became part of the family, they were my confidence.”

Back To The Business Of Life

Alberto is still growing accustomed to life with his new heart. His motto is, “it’s not a fast race, it’s a race of endurance. It’s not how fast I go, it’s how secure I get there.” He is much more careful with how he cares for his body, he is more aware of the movements he makes and is careful not to put too much strain on his muscles until he recovers his full strength.

Now, Alberto is back to running his construction business, Prince Construction, with a keener outlook on life.

Alberto wakes up each day with gratitude, “you appreciate now what used to be somebody else’s heart, and it’s a heart that you take care of and every day the first thing you do is thank God for being alive and pray for the donor and the family who were generous enough to allow their sibling to provide a heart for you to keep living.”

He wants others experiencing a weakened heart or coping with advanced heart failure to know that, “there is hope that there are ways to overcome it, and with faith and determination and with professional knowledge of the doctors you are in great shape to recover."

Have any questions?

We are here to help! Contact us for more information about advanced heart failure or to schedule an appointment. Call us at 202-877-3627.

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Advanced Heart Failure

Advanced Heart Failure

Many patients find they can manage their heart failure and maintain their quality of life with lifestyle changes and basic medicines prescribed by our doctors.But if the condition worsens, we also offer powerful medications, sophisticated devices to help the heart and even transplants. The cardiologists and surgeons in our Advanced Heart Failure Program have the expertise and experience needed to successfully offer these complex treatments.    

Our team will help you decide on the treatment plan that makes the most sense for you. We also work closely with family members and other caregivers. Learn more about the renowned team at our Advanced Heart Failure Program.

Advanced Heart Failure Symptoms

Advanced heart failure symptoms are similar to those experienced by patients with less serious disease. The difference is that symptoms can be felt with minimal exertion or even at rest. These include:

  • Fatigue
  • Shortness of breath
  • Swelling of the legs and feet
  • Swelling of the abdomen
  • Irregular heartbeat (learn more about cardiac arrhythmia)
  • Weight loss
  • Chest pain

 The severity of symptoms can still vary from day-to-day, or even within the same day.

 Learn more about heart failure

Advanced Heart Failure Treatment

Our doctors usually treat less-severe heart failure with lifestyle changes and more common medications. But more advanced heart failure often requires a deeper approach. Possible options include:

  • Inotropes: Medications that increase your heart’s squeezing capacity (only select centers like ours can send patients home on these powerful medications)
  • Cardiac resynchronization therapy (CRT) device: Ensures the right and left side of your heart contract at the same time (learn more about pacemakers)
  • Percutaneous valves: Repair or replacement of heart valves with a minimally invasive approach that avoids open-heart surgery
  • Left ventricular assist devices (LVAD): Devices that help the heart, either as permanent treatment or as a temporary measure before transplant
  • Heart transplant: Replacement of the heart with a donor organ 

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