Transcatheter aortic valve replacement (TAVR), a groundbreaking medical treatment that eliminates the need for open-heart surgery and offers an option for patients who were otherwise considered inoperable, is available now with conscious sedation for qualifying patients, instead of general anesthesia.
TAVR involves feeding an artificial valve by catheter through an artery in the groin or chest to the heart. A team of a cardiothoracic surgeons and interventional cardiologists at HealthPark Medical Center were the first in Florida to offer this procedure outside of clinical trials. It is believed they were also the first Florida team to offer the procedure with conscious sedation.
"This is a big step forward in treating patients with aortic valve stenosis who have no other option," said Brian Hummel, M.D., a cardiothoracic surgeon in Fort Myers. "This is a game changer. We can now perform heart surgery while the patient is partially awake."
TAVR hybrid operating room. PHOTO PROVIDED.
Under conscious sedation, the patient is awake and able to communicate with physicians during the procedure, though he or she has no memory of the surgery after the sedation wears off. It is often used for minor surgery or dental procedures, but is less commonly used in major procedures such as heart surgery. The lighter anesthesia can mean less recovery time and a shorter hospital stay.
"Patients with aortic stenosis are generally elderly and many have comorbidities. They are too weak to undergo open heart surgery," said Hummel. "The advantage of conscious sedation is that high risk patients such as those with respiratory illness or lung disease can avoid the possible complications of general anesthesia."
Aortic valve stenosis is an age-related disease that affects approximately 300,000 Americans. Calcium deposits in the heart valve cause it to narrow and stiffen, making it harder for the heart to pump blood to the rest of the body. Patients experience fainting, chest pain, arrhythmia and cardiac arrest. Without an aortic valve replacement, 50 percent of patients will not survive more than two years after the onset of symptoms.
"These patients are usually very weak. The short commute from living room to kitchen can be too much for some of them. After TAVR, they often describe their recovery as miraculous. They are enjoying life again, golfing, dining out, and feel ten or 20 years younger," said Hummel.