For a doctor, the hardest conversation you ever have with patients is when you have to tell them, “No, there’s nothing I can do for you.” I went into medicine to make folks better. When you can’t do that, it’s like admitting your own fallibility. You feel you’ve hit a brick wall.
Until just a few years ago, that was the case for high-risk patients with severe aortic stenosis, which is a narrowing of the crucial valve exiting the heart. The restricted blood flow results in shortness of breath, severe fatigue, a poor quality of life — and a prognosis for survival worse than many cancers.
We could fix this for many people by replacing the aortic valve through sternotomy, which means splitting the breastbone to perform open-heart surgery. But for others, the risk that they could not survive such major surgery ruled out that option. Our hands were tied.
Then TAVR came along. That stands for Transcatheter Aortic Valve Replacement, a procedure in which surgeons insert a new valve into an artery — usually through the groin — and then guide it into place.
I can’t overemphasize that this is the biggest game-changer I have seen in 30 years of practicing cardiac surgery.
After years of studies and trials, the U.S. Food and Drug Administration has approved TAVR for extreme-risk, high-risk and intermediate-risk patients. As research continues in the next few years low-risk patients are being studied to see if TAVR would be an option for them.
That is because TAVR produces results that are just as good or better than surgical AVR, with less risk to the patient and a much easier recovery. After a conventional aortic valve replacement, the patient stays in the hospital for five to seven days. It’s a longer recovery. But after the TAVR procedure, some patients are ready to go home the next day or in two or three days. And they can bounce back a lot more quickly. It’s just a much more efficient way of treating aortic stenosis.
Revolutionizing Cardiac Surgery
At the Center for Valve Disorders, part of Baylor Jack and Jane Hamilton Heart and Vascular Hospital in Dallas, we have performed about 500 TAVR procedures over the past four years, and we’re picking up the pace every year. It’s very gratifying to see patients do really well and get well in a hurry. We’ll see some folks the day after the operation and they’ll say, “Wow. I can take a deep breath.” It’s that dramatic and it’s that instantaneous.
And as a cardiac surgeon, it’s also great fun. Before TAVR, usually by the time I saw the patient, there was already a diagnosis and the decisions had been made about what to do.
At the valve clinic, we have a multidisciplinary team of cardiologists, interventional cardiologists, cardiac surgeons and nurse practitioners working together. We evaluate patients, discuss what we’re going to do, see things from other perspectives, learn together, and figure out how to get things done. We’re revolutionizing aortic valve surgery.
To learn more about TAVR and other cardiac treatment options, visit Baylor Scott & White Health.