Heart and Vascular Institute Hits Milestone for Minimally Invasive Heart Procedure

Transcatheter aortic valve replacement (TAVR) is a minimally invasive treatment for aortic valve stenosis, a a condition that occurs when the heart’s aortic valve narrows through calcification. Aortic stenosis reduces or blocks blood flow to the rest of the body. The TAVR procedure is a preferred alternative to open-heart aortic valve replacement surgery, according to James Wu, MD, Chief, Division of Cardiothoracic Surgery at Lehigh Valley Heart and Vascular Institute.

“TAVR is ideal for older patients and those who can’t tolerate surgery. These patients usually go home the next day, or within 24 to 48 hours, whereas open-heart surgical patients are here for five days,” Wu says. “TAVR patients can also go back to normal activities of daily living within one to two weeks, compared to a much longer recovery period for postsurgical patients that can last anywhere from six weeks to two months.”

TAVR is also increasingly being done in younger and low-risk individuals. It is important to have a discussion about durability, ease of procedure and potential need for future procedures with the heart team.

“We have performed more than 1,500 TAVR procedures since the inception of the program in 2012,” says William Combs, MD, interventional cardiologist at Lehigh Valley Heart and Vascular Institute.

TAVR addresses disease of the aortic valve with a new bioprosthetic valve inserted from the groin blood vessel that tracks up into the aortic arch. The valve is ballooned open with either an Edwards Lifesciences device or a self-expanding one that opens up slowly by itself, like a Medtronic Evolut device, Wu explains. He notes that there are no age requirements or limitations for the procedure – it’s an option for any person with symptoms of aortic stenosis or tightness of the aortic valve. He adds that since the procedure has only been performed in the U.S. for about 10 years, long-term data tracking duration of the valves is limited.

“In younger patients, we consider that tissue valves do wear out, necessitating a second procedure or even a third one if the patient is very young. If they can tolerate surgery, we recommend that instead. But for many patients who are 75 and above, this is the optimal treatment for aortic stenosis,” Wu says.

While the Heart and Vascular Institute initially performed about 30 to 40 TAVRs annually, volumes surpassed 1,500 over the past decade, with more than 250 cases in 2021.

“All the operators on the heart team are very experienced, and we are able to decrease patient length of stay and significantly decrease complications,” Wu says.

In the large majority of cases, TAVR is performed through the groin arteries, but occasionally the team has to engage alternative techniques if the blood vessels are very calcified or too small. In these cases in particular, the experience of the TAVR team is invaluable, Wu explains. He also notes Lehigh Valley Health Network (LVHN) participates in a TAVR registry, where its metrics demonstrate positive outcomes.

“The LVHN TAVR program has evolved to the point where it has excellent results, handling a very high volume of cases.”