In November 2016, cardiac care in northern and central Arizona takes a major leap forward with the introduction of Transcatheter Aortic Valve Replacement (TAVR) at The James Family Heart Center at Yavapai Regional Medical Center (YRMC) West.
“It’s life altering for people who are not eligible for traditional valve replacement surgery due to their complex medical status. It’s also important because it expands and elevates healthcare throughout our region.”
Valve replacement surgery – considered the gold standard for treating heart valve disease by cardiothoracic surgeons – is an open heart procedure during which the chest is surgically separated. TAVR, however, is performed through extremely small openings that leave the chest bones in place. While valve replacement surgery typically requires a seven-day hospitalization, people undergoing TAVR are usually hospitalized for three days and back to a normal routine soon after.
“We’re introducing TAVR at exactly the right time,” Dr. Tibi said. “We didn’t want to adopt it before it was determined to be a technique that had merit. We also didn’t want people leaving the community for the procedure.”
TAVR procedures will be performed in YRMC’s recently opened Hybrid Operating Room Suite, considered to be among the finest in the nation. In the Hybrid OR, James Family Heart Center heart specialists diagnose patients using permanently integrated imaging equipment. Immediately following the diagnosis, they are able to perform a non-invasive, therapeutic procedure. The Hybrid OR also can convert to a state-of-the-art operating suite. This allows a seamless transition to a fully functional surgical suite without moving the patient.
“YRMC’s leadership made a substantial investment in the Hybrid Operating Room,” said John Amos, Chief Executive Officer, YRMC. “Because of the vision of Dr. Tibi and YRMC’s Board of Directors as well as the support of the YRMC Foundation and our community, we have all of the tools in place for TAVR.”
During minimally invasive TAVR procedures in the Hybrid OR, specially trained YRMC interventionalists and surgeons will repair the aortic valve without removing the old, damaged valve. Instead, they will insert a replacement valve into the aortic valve’s place. Once the new valve is expanded, it will push the old valve leaflets out of the way and the tissue in the replacement valve will take over the job of regulating blood flow. This process is somewhat similar to stent replacement as TAVR uses a catheter to deliver a fully collapsible replacement valve to the valve site.
Who is eligible for TAVR? The Food and Drug Administration (FDA) currently recommends TAVR for people considered too high risk for traditional valve replacement surgery. For that reason, most TAVR candidates are in their 70s or 80s and often have other complicating medical conditions, such as diabetes or chronic obstructive pulmonary disease (COPD).
“Eventually, TAVR likely will be expanded to include people considered less high risk,” Dr. Tibi said.
The introduction of TAVR at The James Family Heart Center is supported by an expansion of YRMC’s Heart Program. Over the past several years, YRMC PhysicianCare Cardiology has grown to include a cardiac electrophysiologist and three new cardiologists.
“I’m impressed by the quality of physicians, nurses and other healthcare providers in our Heart Program,” said Dr. Tibi, who moved to the Prescott area from Phoenix in 2009 to help establish The James Family Heart Center. “I’ve watched the development of heart programs throughout Arizona for years. YRMC’s is the most stable and steadily growing program that’s been started in the past 15 years.”
TAVR: The Transfemoral Approach
TAVR: The Transapical Approach
TAVR: The Transaortic Approach