The following material contains graphic images of an actual surgery that may be disturbing. Parents are advised that these images may not be suitable for young children.
The Doctors have a front row seat to watch a groundbreaking nonsurgical alternative to open-heart surgery. Streaming live from University Hospitals Cleveland Medical Center, the TAVR procedure will be performed by cardiac surgeon Dr. Joseph Sabik, interventional cardiologist Dr. Guilherme Attizzani and advanced interventional cardiology fellow Dr. Amer Alaiti. Dr. Sabik explains the entire procedure while it is being performed on their patient, Kay, who is actually awake the entire time!
This procedure is for patients with aortic valve disease and is much less invasive than open heart surgery. During open heart surgery, the chest is opened, the patient is put on a heart-lung machine, and the heart is stopped. In this alternative valve replacement method, none of those things are done. There is no incision but rather a small puncture. Patients are typically in the hospital for only about a day or two and are back to normal life in less than a week. Comparatively, after open heart surgery patients typically are in the ICU for a few days, then the hospital for a few more, and recovery is 6-8 weeks.
Dr. Sabik explains this procedure is best for patients who are at high-risk for surgery. When high-risk patients compared their outcome of this procedure to open heart surgery it was equally effective and beneficial because it didn’t have the morbidity associated with surgery. Now, studies show that about another 20% of patients with aortic valve disease, those with intermediate risk, are also good candidates for this. Today, they are allowed to do this in 20-25% of the population who have aortic valve disease. This has been amazing in that it allowed people with aortic valve disease who weren’t candidates for surgery to receive a valve replacement.
The procedure is done by threading a catheter which is inserted through an artery in the groin and the catheter goes through the present aortic valve which is blocked. The surgeons use a method called crimping, in which they load the replacement valve into a catheter and when it’s crimped and delivered through they are able to enlarge it and move the old valve out of the way to make room for the new one. Watch the video below to see what that valve looks like and how the surgeons use x-ray technology to track what they are doing.
Dr. Sabik explains a balloon is inserted inside the native valve so it will open it up. To make sure the balloon doesn’t move the surgeons very quickly make Kay’s heart beat extremely fast so that it doesn’t pump blood out. You’ll notice that Dr. Attizzani is actually communicating with Kay to let her know exactly what she is going to feel and sense! The valve is going in…
The most critical part of the surgery is being performed where the surgeons make sure the valve is in the correct place before they release it. As they begin to release it Dr. Sabik explains it “looks like an umbrella that’s opening.”
The procedure is almost finished! The surgeons insert a dye into the ascending aorta to see if the valve is functioning. The dye is staying above the valve and not leaking into the heart which is what they want! The valve is not completely released until they are certain it’s in the correct position.
The procedure was a complete success and the surgeons are very happy with the results. Kay says she is doing great! The procedure is available across the U.S. and if you’re interested, talk to your doctor and find a cardiology group that is an expert in the area.
If you are a patient who is possibly having a procedure, check out The Doctor’s prescription here on what to do first.