Winter Haven Doctor Offers TAVR Treatment That Once Required Travel
by TERESA SCHIFFER
For patients suffering from aortic valve stenosis, there used to be little to nothing that could be done to restore heart health. As little as two decades ago, high-risk patients who experienced this narrowing of the aortic valve opening faced a very discouraging prognosis. However, as health care advances and technology improves, solutions are being found for more and more previously fatal conditions each year. This is the case for aortic valve stenosis, as an innovative treatment called transcatheter aortic valve replacement (TAVR) has been developed and is now being offered locally by BayCare Health System at Winter Haven Hospital.
Dr. David Dodd
For the past 50 years, the standard treatment for aortic valve stenosis was surgical valve replacement, which drastically improves a patient’s symptoms, quality of life, and longevity. Medical researchers were interested in finding a way to deliver a pericardial or tissue valve to the aorta without opening the chest cavity. The first catheter-based balloon aortic valvuloplasty was developed in 1985 by G. Alain Cribier, MD, FACC. Over the years, the technology was refined, until the first human percutaneous (through the skin) implantation of a TAVR was performed in 2002.
Dr. David Dodd is the cardiovascular surgeon with BayCare at Winter Haven Hospital who specializes in TAVR treatment. He discusses what makes this procedure different and beneficial to patients. Dodd, who has been a practicing surgeon for 28 years, explains why this procedure was necessary: “The impetus to look at a new technology was the fact that we, the community of cardiothoracic surgeons, were being asked to see patients with symptomatic aortic stenosis. This is a condition where the valve has become calcified or scarred and it doesn’t open or close properly.”
The result of this condition is that the heart works harder than it should due to obstruction, which can then interfere with the body’s ability to deliver oxygen to that muscle. The heart muscle thickens, and it will get to a point where valve replacement is no longer an option.
TAVR was developed as a treatment for patients that were high risk because they were elderly, frail, or had other medical conditions complicating their diagnosis. Before TAVR, these patients were often relegated to a painful last two or three years of ongoing heart failure before finally succumbing to death. The treatment proved highly effective and was ultimately approved by the FDA for use on a broader range of patients. Almost every year improvements are being made to the valves making them easier to implant and more effective.
Winter Haven Hospital is proud to now have the capacity to offer TAVR treatment to patients. “In order to safely put these valves in, it requires a hybrid operating room,” Dodd explains, “and that is basically a cath lab where we have the ability to actually open the chest and put somebody on cardiopulmonary bypass to perform open-heart surgery if needed.”
This is a welcome addition to the Bostick Heart Center, which added the Structural Heart and Valve Program over a year ago. Patients requiring TAVR treatment have been referred to one of two sister hospitals up to this point—either St. Joseph’s Hospital in Tampa or Morton Plant Hospital in Clearwater. Morton Plant was an early adopter of TAVR technology and consequently has a great deal of knowledge and experience to share concerning this procedure.
Although TAVR has been approved for intermediate and low-risk patients in the past few years, it is still important to take certain factors into consideration as to who is going to be a good candidate for the procedure. The patient’s age, for example. Since the implanted valve is made of living tissue harvested from porcine or bovine sources, it will eventually wear out. However, unlike with mechanical valves made of metal, it is not necessary to take an anticoagulant with a tissue valve. Therefore, lifestyle is another factor to consider.
When assessing a candidate for TAVR treatment, a very extensive workup is involved. One of the first tests administered is a frailty test. Frail patients with aortic stenosis are excellent candidates for TAVR. Intermediate and low-risk patients can also be good candidates, though, since this procedure is less invasive than open-heart surgery and requires less recovery time afterwards. The TAVR involves considerably more advanced preparation than traditional surgery. An echocardiogram needs to be done, plus a special CT scan to determine the correct valve size, a carotid ultrasound, lung studies, and more.
The procedure is then performed by a cardiovascular surgeon and an interventional cardiologist together in a hybrid lab. There is also a state-of-the-art imaging system. Surgeons gain access to the arterial system most often through the groin, then push the catheter up the aorta with a wire. The damaged valve is cleared with a balloon, and the replacement valve is then deployed. This is done under fluoroscopic and echocardiographic guidance.
This amazing procedure is now saving people’s lives. Dodd says he looks forward to helping BayCare patients continue to pursue life and happiness in good health with the care and community investment that Winter Haven Hospital is committed to providing.
