(mellow music)
- The aortic valve is the valve that sits
between the left pumping chamber in the body.
When the heart pumps blood out into the body,
it pumps it through the aortic valve
into the major blood vessel called the aorta.
When a valve becomes stenotic, it begins to calcify,
and so it takes more and more pressure
to get the valve open
and when that occurs, it causes an overload on the heart
and after awhile, the heart begins to fail.
And so when a patient develops severe aortic stenosis
with heart failure and chest pain,
that is when we consider aortic valve replacement.
- The most common symptom of severe aortic stenosis
is exertional shortness of breath
or shortness of breath when a patient tries to exercise
or even do activities of daily living.
Most patients who come to us
with severe symptomatic aortic stenosis
really have an impaired quality of life
and are seeking a way to improve their quality of life
while a transcatheter aortic valve replacement, or TAVR,
is a procedure where we use minimally-invasive techniques
to essentially replace a patient's aortic valve.
- We can do this predominantly with needle puncture
and we don't even need to make an incision.
The most common area that we use
are the femoral vessels down in the groin
and we use any, pass a guide wire up into the heart
and then past the valve on a catheter
over the wire into the aortic position.
And then assess the valve,
determine if we think that this is the ideal position,
if there's any leak around the valve,
or that the valve is opening and closing well,
and if we don't believe that this is a perfect valve,
then we can retrieve the valve and reposition it
and then slowly release it again.
- Because TAVR is a minimally-invasive procedure,
the recovery time from the procedure itself is very short
and so patients recover from the procedure very quickly
and therefore can then begin the process
of getting their strength back
of going through rehabilitation,
and within a period of days to weeks
see significant or dramatic improvements
in their quality of life.
- With a major open heart surgery,
the total recovery time is approximately three months.
With a transcatheter valve replacement,
the total time of recovery
in a ambulating high-risk, moderate-risk patient
is about a week.
They're ready to rock and roll,
they don't wanna be in the hospital,
they wanna get home, they wanna get back,
they wanna get into life,
and so it's very dramatic.
This is one of the big a-ha moments in my life
was seeing the difference between
a post procedure transcatheter valve patient
versus that of a surgical valve patient.
The University of Michigan has been a center of excellence
for aortic valve pathology for many years.
Our aortic valve surgery program
has been the largest program in the state
for approximately the last 10 years
and so we've been known for many years
as an area of aortic excellence.
We have a good history with a large experience,
a good collaborative team,
not only the surgeon and cardiologists,
the anesthesiologists, the echo cardiographer,
the nursing team, the position assistants,
and the technicians in the room.
And so I think when a patient
comes to the University of Michigan,
they get the depth and breath of a complete program.
Any patient regardless of their risk
can have a TAVR with a three way valve.
The whole story with transcatheter aortic valve therapy
is still unfolding.
It has completely changed the landscape
for the treatment of that disease
and the interesting thing about it
was it was one of the best landscapes we had in healthcare
and we improved it.
And TAVR became the gateway of technology
for structural heart valvular therapy.
We have valves that fit
the majority of the patient population
and we feel that we can probably cover
about 97% of the patient population
with this valve range.
- We have access to not only commercially available valves,
but also to several investigational devices
through our clinical trials
to really be able to provide patients
with a breath of options for their valve replacement.
- For many, many years
the only viable option for elderly patients
was either a mechanical valve or bioprosthetic valves.
The TAVR technology is an excellent form of therapy
for the treatment of failed bioprostehtic valves.
Most bioprosthetic valves
usually last about 10 to 15 years in a patient,
so as you're getting into your ninth and 10th decade,
it becomes a bit more cumbersome
to expect to be able to have
what we call a simple surgical valve replacement.
With a minimally-invasive route,
we are able to place a TAVR valve
in the old surgical valve
and relieve any kind of valve dysfunction.
- In the transcatheter aortic valve replacement,
it's required and it is necessary that both
an interventional cardiologist and a cardiac surgeon
really do the procedure together.
- Here at the University of Michigan,
we have done that to the highest level.
I think this helps the patient
who's getting a transcatheter valve
because the cardiologists have superiority and wire skills
and the surgeons have a long history
and superiority of anatomy and the angles
and how to lay a valve in there to the best benefit.
And so when you have the surgeons and the cardiologists
working side by side at the table the whole time
both with a vested interest in that patient,
I think you get the highest level of care.
- I would say 90% of the work
is not the procedure itself,
it's preparation for the procedure.
We have people who schedule cases,
people who talk to the patients
and act as their patient navigators.
We have nurse practitioners
who become true partners with our patients
and act as their advocate throughout the whole process.
Most of our patients
will build a very strong and emotional bond
with their caregivers even before the procedure is done
because we are completely embraced and amassed
and we want them to be partners in the whole procedure.
- They're seen at least by one, perhaps two surgeons
and by one of our cardiologists as well
and then they are presented
at our multidisciplinary conference
where members from cardiac surgery,
from interventional cardiology,
from our imaging cardiology group,
from our nurse practitioners and anesthesiologists,
who would be helping care for these patients
are all present.
And collectively what we do is we present the patient
and come up with the best options for them
before we make a final recommendation to the patient.
- One very important element of our program
is the long-term follow up we have.
We are very proud of partnerships we have built
with our referring doctors
who we consider partners in the care of our patients
and also with the patients' long-term care in general.
There's one of us always on call
to be able to address concerns, issues,
and specifically anything that may come up
no matter how out of the ordinary it is.
It is very important that we do not
consider patients to be a number.
We are just really and truly privileged
to have them be part of our process
and have us be part of their process.
- One of the wonderful things
about being involved in this program
is that I get the opportunity
to work with patients and their families
and see a patient going from being incredibly limited,
short of breath, can barely get out a sentence,
to coming to see us in clinic at their follow-up visit
just a few weeks later
after their transcatheter aortic valve replacement
and now they're walking, they come into clinic
with a big smile on their face,
they're talking about what they've done
over the last few weeks with their family
and things that they haven't been able to do
in months or even years
and about their plans for what they wanna do in the future.
- TAVR, which is now a common place phenomenon,
really wasn't that way about 10 years ago.
The patients who we treated first
were those patients that were not candidates
for open heart surgery,
and what has happened overtime
is that as the success of this technology
has been demonstrated in those patients,
we have then started treating patients
with lower and lower risk.
And our hope is that the majority of patients
with degenerative aortic stenosis
will be candidates for a catheter based therapy
to improve quality of life, to improve recovery times,
and to get patients back up on their feet
and feeling like normal people much quicker.