The team from Doylestown Health’s Woodall Center for Heart and Vascular Care recently completed the 600th Transcatheter Aortic Valve Replacement (TAVR) procedure at Doylestown Hospital.
Doylestown Hospital physicians were among the first in the region to perform the innovative procedure to replace diseased heart valves in patients without open-heart surgery when they completed their first TAVR in late 2013.
Calling the procedure “transformative” for the care of aortic stenosis patients, interventional cardiologist David Boland, MD has been with the team since the beginning of Doylestown Hospital’s TAVR program.
“As the volumes for this procedure continue to grow, it has become the wave of the future,” says Dr. Boland.
TAVR is an advanced treatment option for patients with aortic stenosis. The aorta is the main artery carrying blood out of the heart. As people age, calcium deposits may narrow the valve and it may not open properly, obstructing blood flow from the heart to the aorta and the rest of the body. This condition, called aortic stenosis, generally affects older adults and may lead to heart failure. Symptoms include chest pain, fatigue and shortness of breath, lightheadedness, fainting or difficulty when exercising.
In the past, the only option was to have open-heart surgery to replace the malfunctioning valve. Because of advanced age and other co-morbidities, not everyone can tolerate open-heart surgery. TAVR is another option that offers hope for a better quality of life. TAVR has been shown to be equal or superior to surgical aortic valve replacement in patients across all surgical risk categories, according to the American College of Cardiology.
TAVR now is a treatment option for most aortic stenosis patients. In 2011, it was indicated only for those at extreme risk for surgery. In 2012, high-risk patients were added, followed by intermediate-risk patients (2016), and low-risk patients (2019), according to the Society for Thoracic Surgeons.
Doylestown Hospital uses a team approach to identifying and treating these patients. The team combines the expertise of cardiologists, interventional cardiologists, cardiothoracic surgeons, anesthesiologists and a valve clinic coordinator, all working together to evaluate patients and develop personal treatment plans.
“There is definitely a team commitment,” says Structural Heart Coordinator Jennifer Harrar, DNP, CRNP-BC. “Each individual is evaluated very thoroughly and the patients are very closely followed.”
The team meets regularly to discuss each patient and determine who is an appropriate candidate for the TAVR procedure. Some patients may be eligible for traditional valve replacement surgery, and Woodall Heart & Vascular outcomes for this type of procedure rival the best in the region.
During the TAVR procedure, the physician uses a catheter to thread the small collapsible heart valve through the femoral artery in the groin in most cases; if unable to use femoral access, the team evaluates alternative access. The physician puts the valve and its metal scaffolding precisely into place and the new valve functions like a healthy valve. Since the FDA approved TAVR in 2011, “technology has certainly improved significantly,” notes Dr. Boland.
The team performed the 600th TAVR procedure on February 3, 2022 for an 84-year-old female with aortic stenosis. She went home the next day, as is typical of most TAVR cases.
“Patients typically feel better pretty quick – immediately after the procedure,” says Dr. Boland.
Doylestown Hospital physicians have continued to perform an increasing number of TAVR procedures each year. In 2015, the team completed 34 procedures; in 2021, that number grew to 145. The 30-day mortality rate is 0.7%, well below the national rate of 1.7%.
“I think that speaks volumes to the way the program was initially set up and the quality controls that were instituted from the beginning,” Dr. Boland says. “With a collaborative approach of each team member working hand in glove with the others, the program has worked very well.”
Doylestown Health has built a leading program by staying current with innovative technology and offering patients a range of advanced options. In addition to TAVR, the Structural Heart team offers MitraClip™, a catheter-based procedure for mitral valve repair; pacemaker lead extraction, and the Watchman implanted device, which provides patients with Atrial Fibrillation an alternative to blood thinners to help reduce the risk of stroke.
About Doylestown Health's Heart & Vascular Services
Expert cardiologists and cardiac surgeons assist patients and physicians with managing risk factors for heart disease, offer advanced treatment options and provide outstanding emergency cardiac care. Doylestown Hospital’s accredited Chest Pain Center is fully prepared to treat cardiac emergencies around the clock, focusing on rapid diagnosis and effective treatment. The multidisciplinary team at the Woodall Center for Heart and Vascular Care is dedicated to providing the highest level of quality care and patient safety.