Transcatheter Aortic Valve Replacement (TAVR)
A 90-year-old Eugene man with critical aortic stenosis has a new lease on life after transcatheter aortic valve replacement (TAVR).
The less-invasive TAVR procedure (pdf) enables the percutaneous placement of a balloon-expandable aortic heart valve in carefully selected patients with severe symptomatic aortic stenosis who are not candidates for traditional open chest surgery. Sacred Heart Medical Center's Oregon Heart & Vascular Institute is one of three sites in Oregon approved to perform TAVR.
Subject: Malvin Marlborough, a 90-year-old Eugene man with severe aortic stenosis and a prior balloon valvuloplasty, complained to his primary care physician of some shortness of breath after a half block of exertion. In walks of a block of more, he experienced angina and dizziness. He had no syncope or significant presyncope.
Diagnosis: The patient was referred to Oregon Cardiology, where he was diagnosed with critical aortic stenosis with acute systolic heart failure. He was identified as a candidate for TAVR and opted to have the procedure performed at Sacred Heart at RiverBend. "They gave me the choice of going to Seattle or staying at RiverBend," Mr. Marlborough said. "I said RiverBend, that's it. If you go to Seattle, you get a whole new set of doctors and you start all over again. Baloney with that."
Treatment: A team including interventional cardiologists Dennis Gory, MD, and Sudeshna Banerjee, MD, and cardiothoracic surgeons David Duke, MD, and Paul Koh, MD, performed the procedure. A pacing wire was placed through the femoral vein into the apex of the right ventricle using fluoroscopy. The Edwards SAPIEN valve was advanced over a rigid guidewire that had been positioned in the descending aorta. The guidewire was then advanced into the ventricle and a balloon catheter was used to dilate the native aortic valve. The balloon was removed. The SAPIEN valve was crimped on another balloon and placed across the native valve over the guidewire. Position was confirmed with multiple injections and a transesophageal echocardiogram (TEE). The valve was deployed.
Outcome: Angiography and TEE confirmed no significant aortic insufficiency upon completion of deployment. Groin after suture showed no significant leak. The patient tolerated the procedure well and left the cath lab with stable vital signs. He was discharged from the hospital five days later. Six weeks after the procedure, Mr. Marlborough was doing well. "I walk the mobile home park every day, sometimes twice a day," he said. "I don't have any kind of pain, nor do I have any shortness of breath. If I stick to my routine, I might put off seeing the Lord a little bit longer."