Mon General First In Region to Offer ‘Life Saving’ Minimally Invasive Heart Valve Replacement Procedure

            Mon General Hospital is the first hospital in north central West Virginia to offer Transcatheter Aortic Valve Replacement (TAVR), an alternative for patients who may not be healthy enough for open heart surgery.

            “The TAVR procedure saved my life,” said Judith King, 70, one of the first two patients to have the procedure performed at Mon General. “With the condition my valve was in, I was told I had two to three months at the max.”

            TAVR is for people who have been diagnosed with severe symptomatic aortic valve disease and who are at high risk or too sick for traditional open heart surgery. This less invasive procedure allows a new artificial valve to be inserted within the diseased aortic valve.

            The first two TAVR procedures were performed at Mon General on November 1, and both patients have quickly recovered.  The surgery was performed by a team including Mon General cardiac surgeons Alexander Nagy, MD and Kee Lee, MD, and cardiologists John McKnight, MD; Richard Smith, MD; Michael Englund, DO; and Firas Almahasneh, MD.

            “TAVR is the ultimate minimally invasive approach to aortic valve replacement because it can be done without opening the chest,” said Alexander Nagy, MD, Medical Director of Cardiothoracic Surgery at Mon General. “The tiny device is inserted through a groin vessel or a small two-inch incision over the upper part of the sternum.”

            Although she is still recovering from the procedure, Judith King had one word to describe the end result – “amazing. I don’t get tired as quickly, I can walk more and breathe,” she said. 

            The Mountain Lake Park, Maryland resident had been very fatigued, had difficulty breathing and was short of breath. In addition to her heart condition, she was being treated for COPD (Chronic Obstructive Pulmonary Disease) and was using a rescue inhaler daily. “Just walking a short distance and I was out of breath,” she said.

            In fact, Judith was admitted to the hospital a day early because she was so dizzy, sick to the stomach and struggling to breathe.

            After the TAVR procedure, “she looks so much better,” says Judith’s daughter Lisa Gaither.  “I can tell a big difference in her. She was grey before the procedure and now she’s got beautiful color. I haven’t seen her breathing this good in years. It’s awesome. We’re so blessed.”

            When the valve problem was first diagnosed at Mon General, Judith and Lisa were told the TAVR procedure would soon be available at the hospital, and so they decided to wait. “We felt we were in good hands,” Lisa said. “I would have taken her anywhere she wanted to go. The team at Mon General was very thorough and we felt very cared about.”

            The TAVR procedure took about an hour and a half. Judith spent six days at the hospital before being discharged.

            TAVR is actually a hybrid procedure and requires the expertise of heart surgeons and interventional cardiologists, who work simultaneously on the same patient,” Dr. Nagy said.

            “Mon General has been preparing for the TAVR procedure for more than two years,” he said. Before the procedure could be offered, a special Hybrid Operating Room had to be added to the hospital. A Hybrid Operating Room is an operating room with Cath Lab capabilities that allows open heart surgery and high quality fluoroscopy.

            The hybrid operating room was constructed adjacent to the main operating rooms on the third floor of the hospital and completed earlier this year. The biggest difference between a regular operating room and the hybrid room is that an imaging system is built into the room, allowing both open and minimally invasive procedures. The room provides cardiologists and surgeons the ability to switch from a diagnostic or interventional procedure to an open surgical procedure without moving the patient.

            The TAVR procedure was approved by the FDA (Food and Drug Administration) in November 2011 after an extensive trial in both the United States and Europe. “Currently the procedure is only approved in the United States for inoperable or high risk patients,” Dr. Nagy said. A nationwide trial for intermediate risk patients is currently underway.

            The TAVR procedure is performed using the Edwards SAPIEN Transcatheter Aortic Valve. This collapsible aortic heart valve is placed into the body via a catheter that is threaded up to the heart through a leg artery or small chest incision. The artificial Edwards SAPIEN Valve replaces the patient’s diseased valve.

             The aorta is the main artery carrying blood out of the heart. Blood enters the aorta, flowing through the aortic valve. Severe aortic valve stenosis is a progressive, usually age-related disease caused by calcium deposits on the aortic valve. This causes the valve to not fully open, resulting in the heart working harder to pump blood through the smaller opening. The heart eventually weakens, leading to problems such as shortness of breath, dizziness, chest pain, heart failure or cardiac arrest. Severe forms can prevent enough blood from reaching the brain and the rest of the body.

            While up to 1.5 million people in the U.S. suffer from aortic stenosis, approximately 500,000 within this group of patients suffer from severe aortic stenosis, according to U.S. Aortic Stenosis Disease Prevalence & Treatment Statistics.  Without an aortic valve replacement, 50 percent of patients do not survive more than an average of two years after the onset of symptoms.

            “A significant percentage of older patients develop severe aortic stenosis,” Dr. Nagy said. “Because of their advanced age, they typically are treated with medicine and are considered too high risk for surgery. Unfortunately, the ‘medical’ treatment for severe aortic stenosis is ineffective.

            “TAVR addresses specifically the needs of these ‘high risk’ patients,” he said.

            “Mon General has a Valve Clinic through which cardiac patients undergo a complete evaluation by a team of cardiologists, surgeons and specialized advance practice nurses,” said John McKnight, MD, a cardiologist at Mon General Hospital. “Based on those results, patients are given the best treatment options, which include surgical repair or replacement of a valve through a minimally invasive procedure such as TAVR or classic (surgical) approach.”

            Follow-up care continues to be a team approach through the Valve Clinic and is done in conjunction with the patient’s primary care physician, so the patient retains his or her original doctor.    

            For questions about Aortic Stenosis or other Valvular Heart Disease, Mon General’s Heart Valve Clinic can be reached by calling (304) 598-1735.