Surgeon

Patients with aortic stenosis now have access to the innovative procedure known as transcatheter aortic valve replacement (TAVR) at UPMC Passavant. The UPMC Heart and Vascular Institute was the first program in western Pennsylvania to treat aortic stenosis with this less invasive alternative to open heart surgery. TAVR programs are offered at both UPMC Presbyterian and UPMC Shadyside.

Aortic stenosis is a common condition in which one of your heart valves has calcium buildup. Among the four heart valves, the aortic valve is the most important. As we age, approximately 5% to 8% of patients over the age of 65 will develop a buildup of calcium on the leaflets of this valve.

“The TAVR procedure is a way to replace the valve when that calcium buildup becomes severe and restricts the normal motion of the aortic valve,” says David West, MD, cardiothoracic surgeon and director of cardiac surgery at UPMC Passavant. “The surgery takes approximately an hour to complete, and it’s performed with an interventional cardiologist alongside a cardiothoracic surgeon.”

Patient Benefits of Transcatheter Aortic Valve Replacement (TAVR)

Since TAVR is a faster and less invasive procedure, patients normally leave the operating room, spend a few hours in recovery, and then stay overnight in the hospital – without the need for intensive care unit (ICU) monitoring.

“It’s really benefitted our patients because they feel better quicker,” says Dr. West. “When we look at quality of life scores, patients indicate that they don’t even realize they had the surgery a week later. It may take several months before we see those kinds of gains with open heart surgery.”

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Symptoms of Aortic Stenosis

Patients with aortic stenosis may experience these acute symptoms:

  • Shortness of breath
  • Chest tightness
  • Fainting

“If not treated, aortic stenosis is one of those conditions that clearly impacts mortality. Once this valve starts to cause symptoms, there is a 50% chance that a patient will die over the next 12 to 24 months if the condition is left untreated,” says Dr. West.

How was Aortic Stenosis Treated Previously?

Traditional open heart surgery was the gold standard up until the last eight to 10 years. During this type of surgery, a cardiothoracic surgeon split the sternum — the breastbone – and exposed the aortic valve. Next, the aortic valve leaflets were removed and then hand-sewn into a new aortic valve.

Treating aortic stenosis with an open heart procedure took approximately three to four hours in the operating room. Then, patients would need critical care afterward, spending a night or two in the ICU, and about five days in the hospital, in total.

Who is a Candidate for TAVR?

Originally, TAVR was utilized for patients who could not undergo open heart surgery, or surgical aortic valve replacement. Since then, UPMC has conducted multiple, rigorous clinical trials evaluating the effectiveness of TAVR compared to traditional open heart surgery.

“After a decade of intense research, the whole paradigm has shifted,” says Dr. West. “Now, we consider surgical aortic valve replacement only for those patients who are not a candidate for TAVR. We’ve done a 180-degree turn with respect to eligibility and who this approach is appropriate for.”

Evaluating and Treating Certain Types of Aortic Stenosis

Patients who have bicuspid aortic stenosis tend to present much earlier, often in their late 40s or early 50s. Bicuspid aortic stenosis occurs when the valve only has two leaflets, whereas a normal aortic valve has three leaflets. “In those types of patients, we traditionally recommend an open heart operation with a mechanical aortic valve, which will last for as long as the patient continues to take a blood thinner. That could be 20, 30, or 40 years,” says Dr. West.

There are other factors that UPMC Heart and Vascular Institute experts look at for patients who are in their 70s or 80s with a three-leaflet valve problem called senile calcific aortic stenosis. “In those patients, we get a dedicated CT scan where we can analyze the anatomy so that we can determine what is the best therapy for them,” says Dr. West.

About Heart and Vascular Institute

The UPMC Heart and Vascular Institute has long been a leader in cardiovascular care, with a rich history in clinical research and innovation. As one of the first heart transplant centers in the country and as the developer of one of the first heart-assist devices, UPMC has contributed to advancing the field of cardiovascular medicine.