HJAR Jan/Feb 2021

HEALTHCARE JOURNAL OF ARKANSAS I  JAN / FEB 2021 55 Aravind Rao, MD Interventional Cardiologist CHI St. Vincent Heart Institute catheter to replace the heart valve instead of opening up the chest and completely re- moving the diseased valve. While a number of factors may prevent patients from being able to undergo a TAVR procedure, the new Transcaval TAVR technique allows heart sur- geons to safely bypass calcified arterial re- gions and significantly expand noninvasive surgical options for patients. In the case of the first Arkansas patient to undergo the Transcaval TAVR procedure, the femoral access route used for a normal TAVR procedure was heavily calcified, and she had no other option for a valve replacement. Car- diovascular surgeon Dr. Thomas Rayburn and I worked with the patient over a period of six months. Throughout that time, she had full faith in the Heart Institute and didn’t want to go anywhere else. It’s now beenmonths since the surgery, and she’s doing great. Although originally only approved for pa- tients deemed high risk for open heart sur- gery, studies eventually showed that TAVR procedures were equal or superior to tra- ditional aortic valve replacement surgeries. In August 2019, the U.S. Food and Drug Ad- ministration expanded the approved scope to include patients that were deemed low risk for open heart surgery as well. Today, wheth- er someone is low risk, moderate risk or high risk, we have learned over the years that all patients benefit from this minimally invasive technique. That’s why we have a multidisci- plinary team where we determine the best treatment option for each individual patient. With their less invasive approach, the TAVR and Transcaval TAVR heart proce- dures also provide dramatically reduced recovery times and improved quality of life for patients. The average TAVR procedure takes approximately one to two hours to complete and requires an average of a one- night stay in the hospital. On the other hand, open heart surgery takes approximately two to four hours to complete and requires an average of five to seven days in the hospital as well as an additional six to eight weeks of recovery. One of my patients who could barely walk from the parking garage without losing their breath had the TAVR procedure, went home the next day and was out working on their farm three days later. This is quite literally life-changing for our patients with aortic stenosis, one of the most common and most serious valve disease problems. Because of our experience and high vol- ume of these procedures, the cardiologists and cardiovascular surgeons at the CHI St. Vincent Heart Institute are quickly becoming experts in TAVR. In 2020, we became one of three institutions across the 142-hospital and 21-state CommonSpirit Health system recog- nized as a Center of Excellence for TAVR. Now we have expanded access to the minimally invasive and life-changing technique even further with the Transcaval TAVR procedure. This truly marks an incredible step for- ward for Arkansans seeking the very best in heart care. Minimally invasive alternatives to open heart surgery like the TAVR and Trans- caval TAVR procedures offer dramatically re- duced recovery times for patients and higher quality of life with reduced risk. At this point, our team of expert heart specialists can of- fer about any advanced heart surgery tech- nique available anywhere else in the country. Treatment for aortic stenosis depends on the progression of the disease. Medica- tion may be prescribed to regulate the heart, prevent blood clots and manage symptoms in patients with a mild diagnosis. However, the only effective treatment for severe aor- tic stenosis is to replace the diseased aortic valve with a TAVR procedure or open heart surgery. Symptoms of aortic valve disease may include shortness of breath, difficulty when exercising, swollen ankles or feet, rapid or irregular heartbeat and palpitations, an uncomfortable awareness of one’s heart beat- ing rapidly or irregularly, angina or fatigue. The CHI St. Vincent Heart Institute advises anyone experiencing one or more of these symptoms to speak with their primary care physician or heart specialist. n Aravind Rao, MD, is an interventional cardiologist with the CHI St. Vincent Heart Institute and a lead- ing provider of minimally invasive Transcatheter Aortic Valve Replacement (TAVR) procedures in Arkansas. “The average TAVR procedure takes approximately one to two hours to complete and requires an average of a one-night stay in the hospital. On the other hand, open heart surgery takes approximately two to four hours to complete and requires an average of five to seven days in the hospital as well as an additional six to eight weeks of recovery.”