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

The heart team at St. James University Hospital Dublin was the first to perform a human implant of the CroiValve Duo Tricuspid Coaptation Valve technology for tricuspid repair.  

The heart team at St. James University Hospital Dublin was the first to perform a human implant of the CroiValve Duo Tricuspid Coaptation Valve technology for tricuspid repair.  

News | Heart Valve Technology | March 25, 2020
 
A 3-D reconstruction of a cardiac CT scan showing an implanted Medtronic CoreValve TAVR device. Imagine courtesy of TeraRecon. #TAVR #TAVI

A 3-D reconstruction of a cardiac CT scan showing an implanted Medtronic CoreValve TAVR device. Image courtesy of TeraRecon

Feature | Heart Valve Technology | February 24, 2020 | Dave Fornell, Editor
In August 2019, the U.S.
Raj Makkar, M.D., led a multicenter national study comparing outcomes for minimally invasive heart valve replacement to open-heart surgery. Photo by Cedars-Sinai. TAVR performs as well as surgery for aortic valve replacement.

Raj Makkar, M.D., led a multicenter national study comparing outcomes for minimally invasive TAVR heart valve replacement to open-heart surgery. The study showed the two methods have similar outcomes. Photo by Cedars-Sinai.

News | Heart Valve Technology | January 31, 2020
January 31, 2020 — A new study from the Sm...
Abbott Tendyne TMVR, TMVI system received European CE mark clearance in January 2020. The Abbott Tendyne transcatheter mitral valve replacement (TMVR) system uses an anchor attached to the apex of the heart with a whether line attached to the valve. This helps to keep the valve anchored in the mitral annulus and prevent embolization. This anchor system was used because, unlike the aortic valve, the mitral valve has a very thin landing zone to secure the valve. Prevents LVOT obstruction.

The Abbott Tendyne transcatheter mitral valve replacement (TMVR) system uses an anchor attached to the apex of the heart with a whether line attached to the valve. This helps to keep the valve anchored in the mitral annulus and prevent embolization. This anchor system was used because, unlike the aortic valve, the mitral valve has a very thin landing zone to secure the valve. The design also eliminated any hardware hanging or folding into the left ventricle, which could cause left ventricular outflow track (LVOT) obstruction, which can prevent blood flow through the aortic valve and to the rest of the body.

Feature | Heart Valve Technology | January 30, 2020
January 30, 2020 — The Abbott Tendyne Transcatheter Mitral Valve Implantation (TMVI) system received European CE mark
This is the latest version of the MitraClip, the G4, which allows each side of the clip to be opened and closed independently to offer more flexibility when capturing the valve leaflets. The device is being used in the REPAIR MR clinical trial.

This is the latest version of the MitraClip, the G4, which allows each side of the clip to be opened and closed independently to offer more flexibility when capturing the valve leaflets. The device is being used in the REPAIR MR clinical trial. 

News | Heart Valve Technology | January 13, 2020
January 13, 2020 — The U.S.
The Wyss Translational Center in Zurich, Switzerland has developed the LifeMatrix platform to engineer tissues that can be implanted in patients and will grow with them. This technology is being developed for heart valves in younger patients to eliminate the need for repeat surgeries to implant larger prosthetic heart valves as the patient grows.

The Wyss Translational Center in Zurich, Switzerland has developed the LifeMatrix platform to engineer tissues that can be implanted in patients and will grow with them. This technology is being developed for heart valves in younger patients to eliminate the need for repeat surgeries to implant larger prosthetic heart valves as the patient grows.

 

News | Heart Valve Technology | December 26, 2019
While transcatheter heart valve replacement and repair devices are growing in popularity due to their delivery and qu
A sample of the transcatheter mitral valve replacement (TMVR) devices in development or clinical trials.

A sample of the transcatheter mitral valve replacement (TMVR) devices in development or clinical trials.

Feature | Heart Valve Technology | November 27, 2019 | Saipriya Iyer
The overwhelming success story for transcatheter aortic valve replacement (TAVR) moving from a science project to bec
A key slide from the TRILUMINATE study one-year results showing the improvement in tricuspid regurgitation from basement with treatment using the transcatheter TriClip device.

A key slide from the TRILUMINATE study one-year results showing the improvement in tricuspid regurgitation from basement with treatment using the transcatheter TriClip device.

News | Heart Valve Technology | November 26, 2019 | Dave Fornell, Editor
November 26, 2019 — The preliminary one-year results of the TRILUMINATE Pivotal Study for Abbott's TriClip device, a
Overlay Init