About 20 months after it’s first “transcatheter aortic valve replacement,” a minimally invasive procedure commonly known as TAVR, a team at Bethesda Heart Hospital , part of Baptist Health South Florida , performed it’s 100th TAVR on a critically ill 69-year-old man who is now on the road to a full recovery.
The milestone for Bethesda Heart, located at Bethesda Hospital East , is noteworthy on many counts. Its TAVR program launched on the eve of the pandemic — and now it’s thriving. Over the last few years, TAVR has emerged as the go-to procedure for patients with diseased aortic valves. And now it’s available for a wider range of patients at different risk levels.
And, most significantly, all of Bethesda Heart’s 100 TAVR cases have had successful outcomes — with no complications.
“There is definitely a greater awareness in the community and among primary care doctors and cardiologists about the benefits of TAVR,” said George K. Daniel, M.D. , interventional cardiologist at Bethesda Hospital East , who has been performing TAVR for eight years. “We’re also at an acceleration point with the approval of low-risk patients as candidates for the procedure. We’re doing TAVR almost every day now.”
Expanding TAVR Care Team
The accelerated pace is fueling the expansion of Bethesda’s TAVR program, which is adding a nurse to assist Dr. Daniel and Elyce Kwasman, APRN, the Valve Clinic coordinator, said Jane Kiah, assistant vice president for Cardiovascular at Bethesda Heart Hospital.
The aortic valve, one of four valves that regulate blood flow through the heart, undoubtedly serves a vital function. For most patients, having to replace a diseased valve because of a narrowed opening (stenosis) requires the potential ordeal of open-heart surgery, along with its possible complications and weeks, if not months, of recovery.
Over the last few years, TAVR has become more widely available for patients at all risk levels. Before 2018, it was primarily reserved mostly for patients so old and sick they likely would not survive open-heart surgery. Now, TAVR has become a superior option to those heart-valve replacement candidates who are considered “low risk” for open-heart surgery. Baptist Health South Florida has been a leader in TAVR and other heart valve repair and replacement surgeries, taking part in clinical trials that helped pave the way for TAVR to become available for younger, healthier patients.
However, Bethesda Heart’s 100th case did not involve a “low risk” patient. Quite the contrary, it was a complex case involving a patient who had previously undergone open-heart surgery.
“He presented with heart failure symptoms and severe aortic stenosis,” said Dr. Daniel. “We felt that he would be best served with TAVR, rather than standard surgery because this would have been his second open-heart surgery. He had bypass surgery in the past, so it would have been a much more difficult recovery time for him. So, we offered him TAVR and he became the 100th case. He left the hospital within three days — typically it’s 24 to 48 hours after TAVR.”
Personalized and Optimized Care
The benefits of TAVR — compared to open-heart surgery — are numerous, says Ms. Kiah. One of those benefits includes using Monitored Anesthesia Care, or “MAC” anesthesia, to sedate TAVR patients, instead of general anesthesia. With MAC, patients are groggy but typically awake and able to follow instructions as needed.
“We started out with an optimized care plan for patients,” explains Ms. Kiah. “Dr. Daniel and Elyce were very open about starting the program and managing patients in an expedited way, meaning discharging them in two to three days. With some TAVR programs, the patients stay in the hospital longer; they all go to the ICU; and they get general anesthesia. We’re using mostly MAC anesthesia; not sending them to the ICU, but to our step-down location (a level below ICU), and discharging them quickly. We have continued to maintain an optimized care plan.”
Patients are provided personalized care that involves contact with family members and full transparency about the procedure. And always being available to loved ones is key to development of Bethesda Heart Hospital’s TAVR program, explains Ms. Kwasman, the Valve Clinic Coordinator at Bethesda Heart Hospital. She is the coordinating nurse practitioner who keeps in contact with patients and their families.
“For instance, this morning, I called the daughter of the most recent TAVR patient,” recalls Ms. Kwasman. “And that’s important because we can’t forget that it’s not just the patients — it’s the family as well. It makes the experience a lot better, and more personalized. And as busy as I am, I will never stop doing that because that’s what sets our program apart. Along with the outcomes that speak for themselves, we talk to the patients, and they know me and they know Dr. Daniel.”