UH Case Medical Center Among the First to Perform Major Heart Surgery Under ‘Twilight’

Valve replacement procedures now being done with patient awake

Article ID: 613911

Released: 18-Feb-2014 12:50 PM EST

Source Newsroom: University Hospitals Cleveland Medical Center

Newswise — CLEVELAND – University Hospitals Case Medical Center cardiologists Marco Costa, MD, and Dan Simon, MD, are among the first in the country to perform transaortic valve replacements (TAVR) while the patient is in a “twilight” sedation, awake and communicating with them during the procedure.

What was previously major, open-heart surgery is now being done percutaneously in the cath lab with excellent results that include less recovery time and improved infection rates. On average, patients receiving the new technique are returning home within 24 hours, dramatically reducing hospital stay duration and overall associated medical costs usually incurred during a lengthy admission.

Additionally, without the need for anesthesia, post-surgical medications to counterbalance the effects of surgery are all but eliminated.

TAVR, also known as transcatheter aortic valve implantation (TAVI), is a minimally invasive surgical procedure that repairs the valve without removing the old, damaged valve. Instead, it wedges a replacement valve into the aortic valve’s place. Somewhat similar to a stent placed in an artery, the TAVR approach delivers a fully collapsible replacement valve to the valve site through a catheter. Once the new valve is expanded, it pushes the old valve leaflets out of the way and the tissue in the replacement valve takes over the job of regulating blood flow.

“The TAVR procedure’s success has already been proven,” said Dr. Costa, Director, Interventional Cardiovascular Center at the Harrington Heart & Vascular Institute at UH Case Medical Center and Professor of Medicine at Case Western Reserve University School of Medicine. “Given the current healthcare landscape of unknown costs and insurance, as doctors we needed to evolve and provide patients with an option that doesn’t involve lengthy time in a hospital bed. This allows us to solve many problems at one time.”

The new procedure is FDA approved for patients with symptomatic aortic stenosis (valve narrowing) who are considered high- risk for standard valve replacement surgery. The differences in the two procedures are significant.

Usually valve replacement requires an open heart procedure with a “sternotomy”, in which the chest is surgically separated (open) for the procedure. The TAVR procedures can be done through very small openings that leave all the chest bones in place or via a catheter in the femoral (leg) artery, so recovery is generally much faster with infection rates also improved.

Predominately, the best candidates for the procedure are those in their 70s or 80s and often have other medical conditions that make them a better candidate for this type of surgery. Although relatively new, TAVR can be an effective option to improve quality of life in patients who otherwise have limited choices for repair of their aortic valve.

About University HospitalsUniversity Hospitals, the second largest employer in Northeast Ohio, serves the needs of patients through an integrated network of hospitals, outpatient centers and primary care physicians in 16 counties. At the core of our health system is University Hospitals Case Medical Center. The primary affiliate of Case Western Reserve University School of Medicine, University Hospitals Case Medical Center is home to some of the most prestigious clinical and research centers of excellence in the nation and the world, including cancer, pediatrics, women's health, orthopedics and spine, radiology and radiation oncology, neurosurgery and neuroscience, cardiology and cardiovascular surgery, organ transplantation and human genetics. Its main campus includes the internationally celebrated UH Rainbow Babies & Children's Hospital, ranked among the top children’s hospitals in the nation; UH MacDonald Women's Hospital, Ohio's only hospital for women; and UH Seidman Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center at Case Western Reserve University. University Hospitals Case Medical Center is the 2012 recipient of the American Hospital Association – McKesson Quest for Quality Prize for its leadership and innovation in quality improvement and safety. University Hospitals Case Medical Center is one of only 18 hospitals in the country to have been named to U.S. News & World Report’s most exclusive rankings list: the Best Hospitals 2013-14 Honor Roll. For more information, go to www.uhhospitals.org


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