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Milestones & News

Heart Institute Offers New Approach for Transcatheter Aortic Valve Replacement (TAVR)

Transapical Procedure Offers Option for Elderly Patients with Limited Access through Groin Artery

STONY BROOK, NY, July 11, 2013 — Stony Brook University Hospital is performing a new FDA-approved minimally invasive procedure to replace the aortic heart valve through a small chest wall incision without open-heart surgery, as an alternative for patients with limited access to the aorta through their femoral arteries.

First performed at Stony Brook University Heart Institute on May 29, the transapical procedure is a new approach to transcatheter aortic valve replacement (TAVR). TAVR can be performed by inserting a catheter into the vessels in the groin (transfemoral) or directly into the heart (transapical) to reach the aorta. The procedure allows the diseased valve to be replaced without open-heart surgery.

Members of the TAVR team at Stony Brook University Heart Institute are, left to right: cardiologists Luis Gruberg, MD, FACC, Jonathan B. Weinstein, DO, FACC, Smadar Kort, MD, FACC, FASE, and Allen Jeremias, MD, MSc, FACC; and cardiothoracic surgeons Harold A. Fernandez, MD, FACS, and James R. Taylor Jr., MD, FACS.

The transapical approach is indicated for patients who have inadequate peripheral arterial access for the transfemoral approach, explains James R. Taylor Jr., MD, FACS, professor of surgery at Stony Brook University School of Medicine, chief of the Division of Cardiothoracic Surgery and co-director of the Stony Brook University Heart Institute. Elderly patients in particular may have small-caliber femoral and iliac arteries with limited access.

Transapical TAVR "is generally a quicker technique with greater ease in crossing the native aortic valve and in manipulating the prosthetic valve to be deployed," Dr. Taylor says. It requires an insertion in the patient's chest between ribs to access the apex, or lowest part, of the patient's heart. A sheath consisting of a short hollow tube slightly larger than the width of a pencil is inserted through the apex and into the left ventricle of the heart. A balloon is placed through the sheath to reach the aortic valve, then inflated to break open the narrowed valve to replace it. A new valve is inserted within the diseased valve while the patient's heart is still beating.

Stony Brook became the first hospital in Suffolk County to perform TAVR in December 2012. It was approved by the FDA in November 2011 as a new option to replace the aortic heart valve for patients who are at high risk or are too sick for open-heart surgery. The transcatheter procedure allows the diseased native heart valve to be replaced without open-heart surgery, while the heart is still beating.

TAVR offers hope for patients with severe symptomatic aortic stenosis, which can be life-threatening if not treated. Approximately 500,000 patients nationwide suffer from severe aortic stenosis, but only half of those patients have symptoms of the disease. Patients can develop debilitating symptoms that can restrict normal day-to-day activities, such as walking short distances or climbing stairs. For patients with symptoms, aortic valve replacement is the only effective, long-term treatment option to prevent or delay their disease progression.

Both types of TAVR procedures are being performed at the Heart Institute's Valve Center, which opened in September 2011 and is the only center of its type on Long Island. The treatment team — which includes a cardiothoracic surgeon, interventional cardiologist, echocardiographer, anesthesiologist, and pre-, intra- and post-operative care providers — takes a rigorous, multidisciplinary approach to patient care to ensure appropriate patient selection and optimal outcomes.