Technology has advanced and there’s a new less invasive procedure that could save your life. It’s called Trans-Catheter Aortic Valve Replacement, or TAVR.
Eyewitness News’ Brad Byrd talks to Dr. Dominic Cefali about the procedure, costs, advancement in technology and benefits of a less invasive procedure.
Brad: Welcome to in-depth. Trans-catheter aortic valve replacement – that’s a mouthful. But it could save your life so we will refer to it as TAVR. This is a breakthrough in heart surgery. And it’s being used right here in the Tri-State. And joining me tonight is Dr. Dominic Cefali, a board-certified thoracic surgeon at the Deaconess Heart Hospital. And thank you very much for being with us Dr. Cefali – my goodness how the technology has changed and saved lives. Before we get into that technology, talk to that person out there who may be worried, gosh I’m getting tired or what have you, who’s a candidate for this procedure you’re going to be talking about? What are the symptoms they should be on the lookout for?
Dr. Dominic Cefali: Thank you for having me here, Brad. It’s a great question. I think anyone in general who experiences shortness of breath, chest pain, propensity, to potentially pass out, maybe experiencing some swelling in their legs. They could have their family physician look at them see if they have a heart murmur, and then they can take the evaluation from there. Eventually it would lead to an echocardiogram, which would image the heart and look at the specific cardiac valves, if the aortic stenosis is found then they may potentially be a candidate for this procedure.
Brad Byrd: And an aortic stenosis, tell me what that is exactly in laments terms.
Dr. Dominic Cefali: There’s four major valves in the heart. The aortic valve that helps blood pass from the major pumping chamber to the left ventricle to the stomach circulation – to the rest of the body. That valve is normally very pliable, kind of like tissue paper, maybe a little more substance than that. But over time, with age, some with pneumatic fever, or age itself, that valve can calcify.
Brad Byrd: For years, heart valve replacement surgery has been a surgery. And what has been the normal procedure for that?
Dr. Dominic Cefali: The standard procedure for myself and my surgical partner, we’ve been doing open surgical open valve replacements for the two decades we have both been here. And it’s a very good operation, excellent results, low risk in the majority of patients and a good lifestyle afterwards with valves that last for a while.
Brad Byrd: And very invasive?
Dr. Dominic Cefali: Yes, absolutely.
Brad Byrd: You’re opening up the chest cavity. And that’s why this procedure you’re going to be talking about now is so important. We have the animation you sent us, if we could roll that. Tell me what we are seeing right here.
Dr. Dominic Cefali: Unlike the open surgical procedures, a catheter is being sent through the femoral artery, then into the aorta, then past the diseased aortic valve. The new valve is in place, the balloon that will shortly inflate, the valve is in place, which you’ll see. You can see that valve that is barely moving. There’s the balloon going up and the new one being deployed. And all this is being done through a catheter in the groin, not an open procedure. And then you’ll get to see the new valve beating normally again shortly.
Brad Byrd: And this is all done without cutting anyone open?
Dr. Dominic Cefali: This is all done with small incision that goes in the groin artery and groin vein without any major openings of the vessels.
Brad Byrd: So, when could someone go home after they get this done?
Dr. Dominic Cefali: Usually, the first day after the procedure.
Brad Byrd: the first day after the procedure?
Dr. Dominic Cefali: I’ve been trying to encourage another doctor to think of maybe the day of the procedure. But he’s in charge of the procedure.
Brad Byrd: The technology has changed so much, the cost of this procedure. Who are the candidates who would have to face this? Young? Old?
Dr. Dominic Cefali: Those are great questions. Well, I think we’re evolving in our understanding who the best patients are for this procedure. The primary indication are the highest risk patients or patients prohibited from having open heart surgery. And the result has been good through a series of trials, called the partner trials. We have been moving toward more and more healthier patients. Intermediate risk patients. Walking around, debilitated, but the future is actually looking brighter and brighter. The data is starting to support maybe the patients who are lower risk, younger patients, healthier patients, but all this is still in evolution. But I think the future is very bright for this procedure.
Brad Byrd: And with that being said, the cost involved in this, if you’re an elderly person, on a limited income, who has insurance, a typical household. Is insurance going to pay for this?
Dr. Dominic Cefali: Like any new technology, it does cost money to recapture the research and development costs – to bring this to the forefront. It is expensive. But costs will lower as more competition occurs. As more companies bring these alternative valves onto the market. It’s expensive, but patients are getting out quicker, starting a healthier lifestyle quicker than open heart surgery.
Brad Byrd: When you did this procedure for the first time, what went through your mind and your heart?
Dr. Dominic Cefali: The thing that’s really important to remember here is what’s evolved here is we have a structural heart team and we have a heart team approach. It’s not just me by myself. It’s a team effort and it’s finely tuned. We brought the technology here and put it together to the point where we work together well, we have an excellent group of people, I really wasn’t that nervous. It was well coordinated. It’s gone very well, we’ve done over a hundred, with excellent results, with low rates of morbidity, which is death or complications.
Brad Byrd: Well heart disease still the number one killer in this country. Dr. Cefali, thank you.
(This story was originally published on July 16, 2019)