TAVR, Innovation, and the Future of Healthcare | The Doctor Weighs In
By: The Doctor Weighs In
Tags: Cardiology, Heart, Healthcare, Surgery

By: Fahed Bitar, MD

Minimally-invasive procedures such as TAVR and a team-based approach to medicine are two types of innovation that provide patients with better overall care.

Angiogram of Healthy Heart (Photograph by SPL/Photo Researchers, Inc.)

The role that innovation plays in the future of health care and medicine continues to be a hot topic across the nation. An important example of a technology innovation available today is transcatheter aortic valve replacement (TAVR). The procedure helps patients recover more quickly because it involves minimally invasive surgery instead of open-heart surgery.

Conversations about innovation in healthcare touch on a wide variety of topics, including access to health care, upskilled health workers, and overall cost. However, one thing is certain: when it comes to innovation, patients want access to lower-cost treatment options, including procedures, that offer better outcomes. TAVR does both of these things.

As physicians who are stewards of medicine, we owe it to our patients to bring new, innovative forms of care to the communities we serve. This includes:

looking at all of the ways that we can be more efficient when using technology

having an increased working knowledge of the latest innovations available for our patients, and

providing better overall value.

The evolution of aortic valve stenosis treatments

As people age, the valves of the heart can harden, thicken and calcify. These pathologic changes can reduce blood flow to the body. This is because the diseased aortic valves don’t open correctly.

This condition, known as aortic valve stenosis, is more prevalent in people 75 years or older. Although there can be other conditions that may cause this abnormality to happen in people in their 60s and possibly younger.

Damaged aortic valves are often replaced by surgeons through open-heart surgery. This requires a surgeon to cut into the chest in order to open the ribcage to operate on the heart. This surgery was initially hailed as a breakthrough because physicians finally had the ability to improve the quality of life of patients with aortic stenosis. However, this major surgery with its large incisions increases chances of post-operative complications such as infections, stroke, longer hospital stays and in the most severe cases, death.

These complications especially affect older patients who are considered high risk. They might be frail or have other ailments, such as kidney problems or lung disease that decreases the chances that they will successfully make it through surgery. This is where the minimally invasive procedure of TAVR provides a great option for high-risk and intermediate-risk patients.

What is TAVR?

TAVR is an innovative surgical option for high-risk patients with aortic valve stenosis. It was first approved by the U.S. Food and Drug Administration in 2011.

The Mayo Clinic describes TAVR is a minimally invasive procedure to replace the aortic valve in people with aortic valve stenosis. As noted above, aortic valve stenosis — or aortic stenosis — occurs when the heart’s aortic valve narrows. This narrowing prevents the valve from opening fully. This obstructs blood from the heart into the aorta and onward to the rest of the body. Aortic stenosis can cause chest pain, fainting, fatigue, leg swelling and shortness of breath. It may also lead to heart failure and sudden cardiac death.

How is TAVR done?

During TAVR, doctors usually access the heart through a blood vessel in the leg. Alternatively, doctors may conduct the procedure through a tiny incision in the chest and access the heart through a large artery or through the tip of the bottom left chamber of the heart.

A hollow tube (catheter) is inserted through the access point. The doctor uses advanced imaging techniques to guide the catheter through the blood vessel, to the heart, and into the aortic valve.

Once it is precisely positioned, a balloon is expanded to press the replacement valve into place in the aortic valve. Some valves can expand without the use of a balloon. When the doctor is certain the valve is securely in place, the catheter is withdrawn from the blood vessel or from the incision in the chest.

Does it work?

To date, more than 100,000 patients have successfully undergone the procedure, according to Edwards Lifesciences. The organization states that TAVR has a ninety percent success rate and only has a less than five percent complication rate.

In recent years the number of TAVR centers throughout the U.S. has grown rapidly from 156 in 2012 to 587 in August 2018. Further, there is an upward trend for more locations opening as TAVR continues to move from a high-risk procedure to a standard of care.

The reason for this growth can be attributed to the benefits that the patient receives. The TAVR procedure is minimally invasive. Therefore, patients have a quicker recovery than the alternative of open-heart surgery which can have patients hospitalized for one week and take four to six weeks to recover.

In fact, we’re typically able to discharge patients within 24 hours after surgery. This reduces the costs associated with hospitalization. And there are generally fewer complications, which is a great benefit to patients. This has encouraged patients to seek out health care systems that offer this type of specialized cardiac care.

The role of innovations in the future

The TAVR procedure offers a minimally-invasive, quick recovery alternative to open-heart surgery. It also highlights yet another innovative advance in patient care: a team-based approach.

TAVR cases require a surgeon, cardiologist, and anesthesiologist as well as specialized nurses, to work together to develop the best protocol for each patient. This moves physicians out of their usual siloed decision-making process into a new model where decisions are made as a group on behalf of patients. This leads to better outcomes and overall care.

As physicians, we must continue to explore ways that we can continue to improve the overall care of our patients. This means looking outside of our individual areas of expertise. We should instead embrace collaboration with other professionals who bring other specializations and perspectives to the table, including primary care physicians and general cardiologists.

This innovative team-based approach is just one way that we can work more collaboratively to improve overall patient care.

The bottom line

At the end of the day, whether it is offering technologically advanced procedures such as TAVR or implementing a team-based approach, providing our patients access to the best and most innovative care is key to continuing our important role as stewards of medicine to usher in a new era of health care.

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Dr. Fahed G. Bitar specializes in Interventional Cardiology and serves as both the Medical Director of the Cardiac Catheterization Lab and the Medical Director of the STEMI Receiving Center, located at Emanate Health Inter-Community Hospital in Covina, California. For additional information, visit www.emanatehealth.org