By SARAH

Upland–The Heart Center at San Antonio Regional Hospital is now offering a promising alternative for patients with aortic valve stenosis who may not be candidates for traditional valve replacement surgery.

Aortic valve stenosis is a narrowing of the heart’s aortic valve. The valve acts in a way that is similar to an old camera shutter–with several pieces (leaflets) that open and close. When the heart contracts, the aortic valve opens to allow blood to flow through. When the heart relaxes, the valve closes to prevent blood from leaking back into the aorta. In some patients, the leaflets in the aortic valve become stiff, reducing their ability to fully open and close and allow normal blood flow. This causes the heart to work harder to push blood through the aortic valve to the rest of the body. Eventually, the heart becomes weaker, increasing the risk for heart failure.

TAVR (Transcatheter Aortic Valve Replacement) is considered a last option for patients who are elderly or have complicating medical issues which make open heart surgery too risky for traditional valve replacement. The San Antonio TAVR team includes cardiologists and cardiac surgeons who evaluate and manage these otherwise inoperable patients to determine whether they are candidates for TAVR. “After having good success in clinical trials on high risk patients, the TAVR procedure is now being used at select hospitals for high to moderate risk patients,” states Hossein Dehghani, M.D.,  and Medical Director of San Antonio’s Coronary Care Unit.

Performed under general anesthesia in the hospital’s cardiac catheterization lab, TAVR is a less invasive procedure that allows physicians to perform the valve replacement through a small incision in the groin. The procedure requires a trained interventional cardiologist and a cardiothoracic surgeon working side by side to deploy the valve in the correct position. An artificial valve is inserted through a large catheter threaded up to the heart guided by x-ray. Once in place, a balloon at the end of the catheter is inflated to prepare the faulty aortic valve for replacement with the new valve.

The first two patients to receive the TAVR procedure at San Antonio were both elderly males. Eighty-nine year-old Andres Lopez was a strong working man his entire life, and had beaten cancer and other health issues. He had no idea he even had a heart issue until a routine physical led to a diagnosis of severe aortic stenosis due to an undiagnosed cardiac murmur. While his symptoms had not yet appeared obvious, “Severe aortic stenosis is a very serious medical problem,” explains Hossein Shayan, M.D., cardiothoracic surgeon. “Without aortic valve replacement, approximately 50% of the people who develop symptoms will succumb within an average of 2 years.”

On the other end of the spectrum, eighty-one year-old Syed Shah had advanced symptoms. Along with chronic obstructive pulmonary disease (COPD) and dialysis for kidney issues, Mr. Shah also had a stent previously placed in his heart for a coronary blockage. Most days he was unable to even get out of bed because the moment he put his foot down he couldn’t breathe due to the heart failure that had developed. Mr. Shah’s quality of life had declined dramatically. “For patients who are elderly and have complicating medical issues, traditional aortic valve replacement through open heart surgery would be too risky,” adds Dr. Dehghani. “TAVR is a life-saving procedure for them.”