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Heart Institute Physicians Perform Advanced TAVR Procedures

DOYLESTOWN – Doylestown Hospital physicians are among the first in the region to perform an innovative procedure to replace diseased heart valves in the sickest of patients without open-heart surgery. The team from the Heart Institute completed the first two Transcatheter Aortic Valve Replacement (TAVR) procedures on October 31, and an additional two procedures on November 21. The Heart Institute is one of only a select few in the region to offer this revolutionary procedure.

Interventional cardiologist Steven Guidera, MD and cardiothoracic surgeon Joseph Auteri, MD, led the team, with James McClurken, MD, assisting, that replaced the valves of an 83-year-old male and an 86-year-old female during the first two minimally-invasive procedures.

"We are thrilled to be able to provide this lifesaving procedure to patients of the Doylestown Heart Institute," said Dr. Guidera. "This minimally invasive technology for heart valve replacement represents a major advance in cardiovascular medicine."

Interventional cardiologist David Boland, MD, and Dr. Auteri led the team for the November 21st procedures, with Dr. McClurken assisting. This time, physicians used the transapical approach (gaining access via the apex of the left ventricle).

"This wouldn’t have been possible without a tremendous amount of teamwork," said Dr. Boland. "Each patient benefits from the collaboration of several physicians and experts, working together to ensure the best possible outcome. We are pleased to be able to offer this procedure to our patients."

All of the patients had severe aortic stenosis along with other health problems. The aorta is the main artery carrying blood out of the heart. As people age, calcium deposits may narrow the valve and it may not open properly, obstructing blood flow from the heart to the aorta and the rest of the body. This condition, called aortic stenosis, generally affects older adults and may lead to heart failure. Symptoms include chest pain, fatigue and shortness of breath, lightheadedness, fainting or difficulty when exercising.

Medications are not an effective treatment for aortic stenosis. Without aortic valve replacement, as many as 50 percent of patients with severe symptoms may not survive more than an average of two years after symptoms begin. In the past, the only option was to have open-heart surgery to replace the malfunctioning valve. Because of advanced age and other co-morbidities, not everyone can tolerate open-heart surgery. TAVR is another option that offers hope for a better quality of life.

"For patients who couldn’t get out of a chair, couldn’t walk 10 steps, they now have a chance at a normal lifestyle," says Jennifer Harrar, CRNP, Valve Clinic coordinator.

Doylestown Hospital uses a team approach to identifying and treating these patients. The Valve Clinic at the Heart Institute of Doylestown Hospital combines the expertise of cardiologists, interventional cardiologists, cardiothoracic surgeons and a valve clinic coordinator, all working together to evaluate patients and develop personal treatment plans. The team meets regularly to discuss each patient and determine who is an appropriate candidate for the TAVR procedure. Some patients may be eligible for traditional valve replacement surgery, and Heart Institute outcomes for this type of procedure rival the best in the nation.

During the TAVR procedure, the small collapsible heart valve is threaded through either the femoral artery in the groin or the apex of the heart (transapical approach) in the chest using a catheter. The valve and its metal scaffolding are precisely put into place and the new valve functions like a healthy valve.

TAVR has been in use in Europe for several years. It was only approved by the FDA in the United States in 2011. The Heart Institute is one of only a few cardiac programs in the region to be approved to offer this advanced procedure. The procedures are performed in the hospital’s hybrid room, which combines capabilities of a catheterization lab and operating room.

The Heart Institute has built a leading program by staying current with innovative technology and offering patients a range of advanced options, such as radial artery access for catheterization, cryoablation for Atrial Fibrillation (AFib), and the convergent maze procedure for more permanent cases of AFib. With TAVR, this alternative to surgery can greatly improve the quality of life for patients.

For more information, visit Doylestown Heart Institute.