TAVR

Transcatheter Aortic Valve Replacement (TAVR)

What is TAVR?

Oklahoma Heart Institute (OHI) is the first center in Tulsa and the region to offer transcatheter aortic valve replacement (TAVR) with the Edwards SAPIEN transcatheter heart valve (THV) for patients suffering from severe, symptomatic native aortic valve stenosis who are not candidates for traditional aortic valve replacement surgery.

TAVR is a minimally invasive option for patients with aortic stenosis (narrowing of the aortic valve). who would be considered too high risk for traditional open heart procedures. TAVR is a state-of-the-art alternative to open heart surgery and has been shown to be highly effective. During TAVR, interventional cardiologists and cardiothoracic surgeons work together to replace the aortic valve with catheters through a small puncture in the skin, most frequently in the groin. This technique allows a new aortic valve to be inserted within the diseased aortic valve without opening the chest as a traditional open heart surgery. This minimally invasive approach allows patients to recover more quickly, reduces the risk of surgical complications, allows patients to go home sooner than traditional surgery and allows the patient to return to a baseline more rapidly.

What happens during TAVR?

The balloon-expandable SAPIEN valve is delivered via a catheter-based approach without a sternotomy (without opening the chest) or the use of cardiopulmonary bypass, and the average hospital stay is two to three days. This transcatheter procedure enables the placement of a collapsible aortic heart valve into the body via the catheter-based RetroFlex 3 transfemoral delivery system, which allows the Edwards SAPIEN valve to be inserted via the femoral artery in the thigh. The valve is designed to replace a patient’s diseased native aortic valve without traditional open-heart surgery and while the heart continues to beat – obviating the need for cardiopulmonary bypass.

It is the only TAVR therapy approved for commercial use in the country and Oklahoma Heart Institute is the first facility in Tulsa and the second in Oklahoma to offer this life-saving procedure. Our Team, which includes an interventional cardiologist, cardiothoracic surgeon, cardiac imaging specialist, anesthesiologist, and pre- and postoperative care providers, takes a rigorous, multi-disciplinary approach to patient care to ensure appropriate patient selection and optimal outcomes.

Who is a candidate for TAVR?

The Oklahoma Heart Institute Team will conduct a comprehensive evaluation to determine whether this procedure is an appropriate therapeutic option. In certain cases, TAVR may not be an option because of co-existing medical conditions or disease processes that would prevent the patient from experiencing the expected treatment benefit or because the risks outweigh the benefits. For those who are candidates for TAVR, this therapy may improve survival (make you live longer) and provide relief from the often debilitating symptoms associated with severe aortic stenosis.

The current ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease recommend surgical aortic valve replacement (SAVR) for virtually all patients with severe, symptomatic aortic stenosis. Without replacement of the aortic valve, this disease is life-threatening and previous studies have shown that 50% of patients will not survive more than an average of two years after the onset of symptoms. While open-heart aortic valve replacement surgery is the gold standard treatment for severe symptomatic native aortic valve stenosis, there are patients who are not candidates for open-chest surgery. These inoperable patients may be unable to undergo traditional surgery because of factors such as age, history of heart disease, frailty or other health issues. For these patients, TAVR may be an option.

Our TAVR team

The Oklahoma Heart Institute TAVR Medical Team

If you plan to undergo TAVR, you will be cared for by the Oklahoma Heart Institute team of cardiac medical specialists who are committed to ensuring your safety and comfort before, during, and after your procedure. Below you will find information describing different health care professionals you may meet during the course of your care.

• Anesthesiologist — The anesthesiologist is trained to provide sedation or general anesthesia (sleep) during surgical procedures.
• Cardiologist  — The physician who specializes in diseases of the heart. The cardiologist does not perform heart surgery but often performs diagnostic tests to identify the cause of heart problems and determine the course of treatment to manage heart disease. The cardiologist may prescribe medications and/or refer you to a cardiovascular surgeon. Find out more about OHI Cardiologists.
• Cardiovascular surgeon — The physician who specializes in heart surgery, including the repair or replacement of heart valves. Dr. Paul Kempe is a cardiovascular surgeon who is an integral member of the Heart Team and is involved in all parts of the TAVR process and procedure.
• Critical care physicians and nurses — The critical care or intensive care unit in a hospital is a specialized area where you are closely monitored and treated following cardiovascular surgery. The critical care team manages your care during this time.
• Interventional cardiologist  — A cardiologist who specializes in minimally-invasive, non-surgical methods of treating heart and vascular disease. During the TAVR procedure OHI interventional cardiologists Dr. Kamran Muhammad and Dr. Wayne Leimbach, who have special training in interventional therapies for structural and valvular hart disease, lead the Heart Team in performing this life saving procedure.
• Primary care physician — May be the first to identify the symptoms of heart valve disease or other conditions that can cause heart valve disease or defects. He or she may order special tests to confirm the diagnosis or refer you to the appropriate specialist.
• TAVR Coordinator  — Anna Richardson, LPN serves as the Coordinator for the Transcatheter Aortic Valve Replacement Program (TAVR Coordinator). She is available to patients and their family members as a resource throughout their testing and procedure. Patients and family members can reach Anna at 918-592-0999 and select option ‘0’ and can ask for her directly.

Transfemoral TAVR Procedure (TF-TAVR) 

• Minimally invasive method to replace diseased aortic valve 
• Performed through the femoral artery in leg 
• Treatment for high-risk with severe symptomatic aortic stenosis 

TAVR benefits and recovery

Aortic valve replacement is the most effective treatment to alleviate symptoms and improve survival in patients with severe/critical aortic stenosis. The incidence of aortic stenosis multiplies with age and as the life span of our population increases and as patients age, a large number will require aortic valve replacement. Since outcomes with medical management are uniformly poor, TAVR is a less invasive alternative for patients with aortic stenosis who need aortic valve replacement. Additional benefits include shorter recovery time, minimally invasive, significantly less pain than with open heart surgery and it’s a life-saving option for patients with severe aortic stenosis.