Heart Center Expands TAVR availability

ST. LOUIS – November 19, 2012 – Missouri Baptist Medical Center has been chosen as one of the few heart centers* in the U.S. approved to offer transcatheter aortic valve replacement (TAVR) to treat high-risk aortic stenosis patients by implanting a new valve either through the ribs or via an artery in the groin, without open-heart surgery.

With TAVR, a new valve is placed directly inside the diseased one.  It is inserted either transfemorally – through an artery in the leg – or transapically – between the ribs. In each approach, the new valve is guided into place through a catheter.

Initially, the FDA approved TAVR as treatment only for inoperable patients, who were judged by two surgeons as unlikely to recover from open-heart surgery, which is the gold-standard approach to valve replacement. Over the past five months, cardiologists at Missouri Baptist have successfully completed transfemoral TAVR procedures in 15 inoperable patients with severe aortic stenosis.

Recently, the FDA approved TAVR for operable, but high risk patients, with severe aortic stenosis, giving these patients the option of traditional surgery, or TAVR carried out either transfemorally or transapically, depending on the size of the major arteries to the leg.

To perform a TAVR procedure, the new valve is crimped and loaded into the catheter-based delivery system and inserted into the body via one of two routes.  In the transfemoral approach the guide wire for the catheter is threaded from a major leg artery to the aortic valve.  In the transapical approach, the guide wire is threaded via a small incision between the ribs directly through the heart. When positioned inside the diseased valve, the new valve is expanded and immediately functions in place of the patient's diseased aortic valve. Watch a video of each approach.

Over 1.5 million people in the U.S. suffer from aortic stenosis, with one-third of these patients considered severe.  More than 20,000 people die each year from heart valve disease.  The majority of U.S. patients with severe aortic stenosis are not considered high risk or inoperable, and may receive an aortic valve replacement through the traditional open-heart surgery, one of the safest heart surgeries performed.

Patients who may be unable to undergo traditional surgery because of multiple high risk comorbidities, frailty or other unique disqualifying health factors, may benefit from TAVR.  Such patients are first evaluated by the Missouri Baptist Heart Team of experienced cardiac surgeons and cardiologists to determine if pre-existing conditions and other risk factors make TAVR a better option.

The safety and effectiveness of the SAPIEN valve were evaluated in a randomized, controlled pivotal study called The PARTNER Trial. The trial was successful in meeting one of its primary endpoints at one year, concluding that survival of high-risk patients treated with the SAPIEN valve was equivalent to those treated with traditional open-heart surgery, which is the gold standard for the treatment of valve disease.

“The TAVR procedure is unquestionably less invasive than traditional surgery; a particular benefit when considering the typically advanced age or frailty of the inoperable or high-risk patient,” said Cardiac Surgeon Michael Mauney, MD, who oversees the TAVR program at Missouri Baptist. “However, TAVR does carry a unique risk of major vascular injury to the leg not seen with surgery.  In addition, the stroke risk associated with TAVR is slightly higher than that seen following surgery, likely related to the acute and lifelong presence of a device within the patients own diseased valve leaflets, which are carefully removed at the time of conventional open aortic valve replacement.”

To find out more about TAVR, visit www.MissouriBaptist.org/TAVR, or to schedule an appointment, call the Heart Valve Clinic at Missouri Baptist Medical Center at (314) 996-5287.

Missouri Baptist Medical Center is an 489-bed acute-care hospital known for its top rated Heart Center. Recognized as a heart surgery center by Consumer Reports; a “Top 100 U.S. Hospital” by Thomson Reuters in 2009, 2010 and 2011; “5-Star Rated for Treatment of Heart Attacks” for the eighth consecutive year  by HealthGrades, and “One of America’s Safest Hospitals” by Forbes, Missouri Baptist Medical Center is a member of BJC HealthCare, one of the largest nonprofit health care organizations in the United States and the largest employer in St. Louis.

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