Five things to know about TAVR procedures at M Health Fairview
Patients with aortic stenosis often have significant shortness of breath, chest pain or feel dizzy or even lose consciousness , so eventually they don’t engage in activities they used to. But a procedure that’s less invasive than open-heart surgery can change all that.
The first transcatheter aortic valve replacement (TAVR) procedure in the world was completed in 2002. Since then, the M Health Fairview health system has done more than 1,600 of the procedures. The transcatheter team at M Health Fairview St. John’s Hospital in Maplewood is one of several leading heart care teams across our health system that performs the procedure.
“I think it comes as a surprise to a lot of people that they can feel better,” said Marat Yanavitski, MD, an interventional cardiologist and structural heart specialist at St. John’s Hospital. “When they come to us, they haven’t been feeling well for a while. They might think they’re just old and frail. Yet, and often to a pleasant surprise, they quite commonly get into better shape after the procedure than they were for a long time prior.”
Yanavitski shares five things to know about the TAVR procedure.
TAVR replaces a failing heart valve.
Aortic stenosis occurs when the valve to the body’s main artery, the aorta, doesn’t open and close properly. That reduces the amount of blood that can flow to the rest of the body. Without adequate blood flow, people can become tired, feel breathless, and experience swelling in their bellies or legs
The TAVR procedure is done to open up the failing heart valve to get the blood moving effectively again. During the procedure, the healthcare team inserts a catheter into an artery in the leg and maneuvers it through blood vessels up to the heart. When it reaches the aortic valve, the doctor inserts a new valve, made from cow or pig tissue, into the old one. With the new valve in place, the heart increases its pumping capacity quickly. The procedure usually only takes about an hour. After a few hours of rest, the patient is usually up and taking a few steps.
Most will stay in the hospital overnight then go home the next day. Patients come back for cardiac rehab within the first week or two.
TAVR can improve quality of life – and quickly.
Some patients don’t even realize that their blood isn’t flowing well because their symptoms come on gradually.
“Sometimes we see patients who think, ‘Well, I’m old. Of course, I can’t walk to the mailbox anymore,’” Yanavitski said. “That's a normal part of aging to some degree. But sometimes patients were getting sick and didn't realize, so they just adjusted their level of expectations.”
Then after the procedure, they are surprised at their own capacity for physical activity.
“It's rewarding for us to see them post procedure and hear, ‘Oh my gosh, I didn't realize how poorly I've been feeling before and now I'm able to do cardiac rehab,’” Yanavitski said.
TAVR could give you more good years – many more.
Without treatment, life expectancy for someone with symptomatic aortic stenosis is often only a couple of years. And they usually aren’t high-quality years of living since breathlessness and weakness can prevent people from partaking in their favorite activities.
But with new heart valves in place, many of Yanavitski’s patients have gotten a second lease on life. A replacement valve lasts about 10 years. And if that one fails, you can get another. The procedure has been done long enough that Yanavitski and team are starting to see patients for their second TAVR and a third lease on life.
“Hopefully we'll get more and more people into this bonus territory,” Yanavitski said. “I lost my dad a couple of years ago. I would give almost anything for another year with him. From personal experience, I know it affects not just the patient but people around the patient.”
More patients are now eligible.
In the early days of the TAVR procedure, it was used only for people who couldn’t have open-heart surgery because their risk was too high. But those patients did so well with the procedure that it's now available to lower-risk populations.
TAVR is an option for nearly everyone with aortic valve failure. It comes with fewer risks and a shorter recovery time than open-heart surgery. But open-heart surgery is still the right choice for some people, particularly those who have other concerns that can be addressed at the same time during the surgery.
At M Health Fairview, the structural cardiology team gathers to discuss each patient and whether to recommend TAVR or surgery. At least two doctors see each patient. While the team offers their recommendations, ultimately the patient is in charge and is empowered to decide on their own treatment.
“A question that people often ask is if they’re too old for this. And the answer usually is no. It’s common that folks could be in the seventh, eighth, or ninth decade of their life, and most of them still could be candidates,” Yanavitski said.
The M Health Fairview team is here to support you.
The core of the TAVR team at St. John’s Hospital has been in place since 2015. They’ve done hundreds of these procedures together – and get better with every one. “TAVR is common, but it’s also one of the most choreographed procedures in medicine right now,” Yanavitski said.
Patients receiving structural heart care work with care coordinators, registered nurses who help guide patients through the process. Care coordinators become a familiar face as patients prepare for their procedure and get follow-up care after. Patients also get a direct line to their coordinator, so they know who to call if anything comes up. Care coordinators are just one part of the team. Many more members of the team review the results of different tests and double check everything. “There are many checks and balances that go into this,” Yanavitski said. “It’s more of a Space X flight than a commute to work.”
Learn more about heart care at M Health Fairview.
