Feature | February 17, 2014

UTHealth, Memorial Hermann Perform Conscious Sedation TAVR Procedure

TAVR Heart valve repair Hybrid OR
February 17, 2014 — A team of interventional cardiologists and cardiovascular surgeons at The University of Texas Health Science Center at Houston (UTHealth) and Memorial Hermann Heart & Vascular Institute-Texas Medical Center performed Texas’ first transcatheter aortic valve replacement (TAVR) under conscious sedation using the Edwards Sapien valve.
 
Conscious sedation, in which the patient is awake and able to communicate with physicians during the procedure, is now used in many TAVR cases in Europe but is much less common in the United States.
 
The procedure circumvents an anesthesiologist inserting a breathing tube for general anesthesia. Conscious sedation can mean less recovery time, a shorter hospital stay and cost savings, physicians have reported. For traditional surgical aortic valve replacements, the hospital length of stay is five to six days. By comparison, the length of stay for TAVRs in Europe can be as low as one to two days.
 
Aortic valve stenosis, which affects approximately 300,000 Americans, is an age-related disease resulting from calcium deposits in the valve that cause it to narrow and stiffen. As it becomes harder to pump the blood to the rest of the body, the heart weakens. Patients experience fainting, chest pain, heart failure, irregular heart rhythms and cardiac arrest. Without treatment, patients usually die within two years of diagnosis.
 
This first case in Texas on Jan. 9, 2014 went so well that when patient Clifford Reed’s wife Helen arrived at the hospital a day after her husband received his new aortic valve, he was dressed and ready to go home. His doctors elected to keep him one more day for monitoring.
 
“We're not removing a tooth or sewing up a wound under conscious sedation, but doing a procedure that in the past required stopping the heart, placing the patient on cardiopulmonary bypass, removing the aortic valve, and suturing a new valve into place,” said Tom C. Nguyen, M.D. assistant professor of cardiovascular surgery at the UTHealth Medical School and cardiothoracic and vascular surgeon at the Institute. “In essence, we're doing heart surgery while the patient is partially awake.”
 
Replacing the aortic valve is traditionally done in surgery in the United States, but some patients are not candidates for surgery. TAVR, which is done via a catheter inserted into an artery, has been studied in Europe and the United States for more than a decade in frail patients who are inoperable or at high risk for open surgery.
 
Doing the procedure under conscious sedation was a natural next step.
 
“As our population ages, more and more of us are going to have these kinds of conditions and the less invasively we can manage them, the better these patients will hopefully be in the future,” said Prakash Balan, M.D., assistant professor of interventional cardiology at the UTHealth Medical School and part of the Institute team performing the procedure.
 
“With this procedure, we were able to put in a new valve while the patient was awake in about an hour and 10 minutes, so that’s a huge advance,” said Richard W. Smalling, M.D., Ph.D., the James D. Woods Distinguished Chair in Cardiovascular Medicine and director of interventional cardiovascular medicine in the Division of Cardiology at UTHealth and the Institute.
 
As he was wheeled out of the catheter lab, Clifford Reed, who is 87, told Nguyen and Balan that he was “feeling a lot better now.”
 
His wife noticed an immediate change.
 
“Before he used to be light-headed and he wasn’t sure on his feet. He also had a lot of chest pain,” Helen Reed said. “Now his chest isn’t hurting and he’s doing great. It’s a miracle.”
 
For more information: www.uth.edu

Related Content

4Tech, TriCinch TTVR, transcather tricuspid valve repair device, first implant
News | Heart Valve Technology| September 22, 2016
4Tech Inc. announced that its TriCinch device has been used in the world’s first-ever successful transcatheter...
Transesophageal Echo, TEE. Interventional echocardiography, interventional echo, Philips, CX50

Transesophageal echo (TEE) has become an essential part of the new transcatheter structrual heart therapies, giving rise to a new sub-speciality of interventional echocardiography.  

Feature | Cath Lab Navigation Aids| September 21, 2016 | Dave Fornell
The rapid growth of transcatheter structural heart procedures and the need for increased use of echocardiography as a
Claret Medical, Sentinal CPS, cerebral protection system, FDA marketing application, TAVR, embolic protection
News | Embolic Protection Devices| September 20, 2016
Claret Medical announced its filing of a marketing application with the U.S. Food and Drug Administration (FDA) for...
Edwards sapien, intermediate risk patients, CE mark
News | Heart Valve Technology| September 20, 2016
September 19, 2016 — Edwards Lifesciences received European CE mark to expand use of the Edwards Sapien 3 transcathet
Valtech Cardio, Cardioband Tricuspid, Cardioband Mitral, PCR London Valves 2016, study data
News | Heart Valve Technology| September 19, 2016
Valtech Cardio Ltd. announced that it will present the first-in-man data for its Cardioband Tricuspid (TR) system at...
Lotus Edge Valve, CE mark, boston scientific, TAVR, TAVI

The Lotus Edge system in its deployed position. The Lotus valve expands outward as it is compressed and buckled in the deployment position. It also has a skirt to help eliminate paravalvular leaks.

News | Heart Valve Technology| September 19, 2016
September 19, 2016 — Boston Scientific received European CE mark approval for its Lotus Edge Valve System, the compan
Xeltis bioabsorbable aortic conduit, endogenous tissue restoration, ETR, preclinical data, ISACB 2016
News | Heart Valve Technology| September 09, 2016
Six-month preclinical data from trials of a Xeltis bioabsorbable aortic conduit were presented at the 2016 scientific...
Pradaxa, dabigatran, GLORIA-AF registry, ESC Congress 2016, NVAF
News | Antiplatelet and Anticoagulation Therapies| September 01, 2016
First outcome results from the GLORIA-AF Registry show that treatment with Pradaxa (dabigatran etexilate mesylate) was...
Edwards Intuity aortic valve, surgical aortic valve replacement, PinnacleHealth, first U.S. implants
News | Heart Valve Technology| August 26, 2016
This week, PinnacleHealth, Harrisburg, Pa., became the first hospital in the country to implant the Edwards Intuity...
Sapien III, Sapien 3, PARTNER III, FDA approval, expanded indication, intermediate risk patients

The Sapien 3 valve has a skirt of fabric at its base that has significantly reduced issues of paravalvular leak, which was an issue with the first generation Sapien device. 

Feature | Heart Valve Technology| August 18, 2016 | Dave Fornell
August 18, 2016 — The U.S.
Overlay Init