TAVR Procedure Expands HCA Hospitals’ Heart-Valve Capabilities

Several HCA hospitals are investing in new equipment and training to treat aortic stenosis, a narrowing of the heart valve that causes fatigue and eventual heart failure. The procedure, known as Transcatheter Aortic Valve Replacement, or TAVR, is much less stressful than open-heart surgery, and is an exciting, new option for older or non-operative patients who are not good candidates for more invasive surgery.

That was the case for actor Jim Nabors, most famous for portraying Gomer Pyle on television. At age 82, he underwent the procedure and was up and around the day following surgery. Similar results have been reported at HCA hospitals, where TAVR surgical suites have been created and interventional cardiologists and surgeons are integrating the procedure into the full complement of heart-treatment options.

“We did our first procedure April 25, and are thrilled to have this procedure to offer to our elderly patients who are not qualified surgical candidates,” said Joan Rotnem, Director of Surgical Services at Sunrise Hospital & Medical Center in Las Vegas.

HCA’s TAVR interventional cardiologists and surgeons use a valve manufactured by Edwards Lifesciences, and perform the surgery in a surgical suite that’s a hybrid of a traditional operating room and a cardiac catheterization lab. The multimillion-dollar suites also will be used for various adult and pediatric cardiovascular and peripheral vascular procedures.

Less Invasive Surgery Means Quicker Recovery

TAVR surgery involves an incision similar to one made during a catheterization process. The physician deploys the new valve via a catheter under fluoroscopy. Recovery is much faster than open-heart valve replacement, with patients up and talking within hours.

“Our first patient was sitting up in bed and talking when I visited him two hours later,” Rotnem said. “He was telling us that we should name the procedure after him.”
For physicians, the new capability means not only can they offer more to patients, they also can work with surgeons and other colleagues in a more collaborative fashion to treat heart patients.

“This is a revolutionary and transformational therapy,” said Dr. Rafael Valencia, an interventional cardiologist who is a member of Sunrise’s heart team. “It’s not just a procedure, but a whole new way of approaching cardiovascular medicine.”

TAVR allows heart programs to capture an entire new group of patients, those deemed as too high risk for regular surgery. It also allows for much more collaboration, Dr. Valencia added.

“We have nurses, administrators, cardiothoracic surgeons, cardiologists … the whole team together now,” he said. “Often we did not know what procedures the others were doing, but now we can look at each patient, and explore the options for their treatment with our new capabilities.”

That’s exactly the outcome that Dr. Steven Manoukian, HCA’s Medical Director of Cardiovascular Services, had in mind when he and his team began looking at what TAVR could offer patients. The HCA system was already heavily involved in the early research phases of TAVR, since Medical City Dallas Hospital acted (and continues to act) as a leading trial partner for the procedure. That facility has now performed more than 300 procedures.

“Developing a network of high-quality, experienced TAVR programs will facilitate access to this promising procedure across HCA. From the research perspective, one of the many benefits of performing this research within the HCA system is the opportunity to bring potentially superior therapies like TAVR to our patients at an earlier time point,” said Manoukian, who also is Director of Cardiovascular Research for the Sarah Cannon Research Institute.

The TAVR program will be up and running by late 2012 at Clear Lake Regional Medical Center, Webster, Texas, and based on input from other facilities and their own research, the doctors and staff there are eager to get started.

“We have a dedicated heart program and Heart Hospital on our campus,” said Charles Laird, Chief Operating Officer. “The TAVR program allows us to continue to build the program and grow into a greater depth of service.”

At TriStar Centennial Heart & Vascular Center in Nashville, five procedures had been completed by June. The results have impressed everyone involved.

“We have an option that has opened up a whole new alternative for folks who before had pretty dismal outcomes,” said Dr. John Riddick, an interventional cardiologist who has taken part in several TAVR procedures. “The two-year mortality rate was between 50 percent and 70 percent for these people, which is worse than most cancers. Now, they not only have access to a new procedure, but one that almost immediately gives them an improved quality of life as well.”