To Bypass Bypass
Anatomy books tell us that the heart has four chambers, the atria and ventricles, which pump blood throughout the body. It also has four valves, which open to let blood flow through or out, then shut to keep it from flowing backward. But sometimes they don’t work properly. When the valve doesn’t open enough, for instance, it blocks blood flow. This is called stenosis, and when it occurs in the valve leading to the heart’s largest artery, the aorta, it often needs to be corrected with open-heart surgery. That’s fine for most of the approximately 500,000 patients who suffer from severe aortic stenosis—but not all.
Some patients, typically the older and more frail ones, cannot handle the rigors of open-heart surgery. In the past, there was little that could be done to help them. But now a new procedure called transcatheter aortic valve replacement (TAVR) offers a minimally invasive way to replace the diseased valve that can be performed on a beating heart, so there is no need for cardiopulmonary bypass with a heart-lung machine. And Westchester Medical Center will soon be one of a few select hospitals—and the only one between New York City and Albany—to perform the procedure on qualified patients.
The TAVR procedure involves the placement of a biological heart valve in the body via the femoral artery with a catheter, the same delivery system used for other catheterization procedures such as angiograms. The valve, mounted on a stent, is threaded through the femoral artery up into the aorta and then inflated to literally squeeze the old valve out of the way, says Westchester Medical Center cardiac surgeon Gilbert Tang, M.D. Then the new heart valve is put in its place.
“This procedure has been around since 2002, but most were done in Europe,” says Dr. Tang. “It was only approved by the FDA in November 2011 for prohibitive-risk [the most serious atrisk] patients, and in October 2012 for high-risk patients.”
To better perform these and other catheterization procedures, the Medical Center is currently building the area’s first hybrid operating room, which will allow surgeons to perform both minimally invasive and traditional procedures in a state-of-the-art facility. “We already have a phenomenal record of treating aortic stenosis with valve replacement the traditional way,” says Andrea Cronin, program coordinator for the Medical Center’s transcatheter valve program. “This new TAVR program gives additional options for those who previously had no options or had to travel to get them.”
Related Read: High-Tech Heart Help