Transcatheter Aortic Valve Replacement (TAVR)

The Less Invasive Therapy for Aortic Stenosis

Community Memorial Hospital is the only hospital in Western Ventura County with a dedicated TAVR team

TAVR Team

Consisting of cardiologists, cardiothoracic surgeons, anesthesiologists, nurses, and Radiology and Cardiovascular Technologists, our TAVR team has received extensive, procedure-specific training and works as a cohesive team to ensure each patient’s treatment is tailored to his or her needs.

Omid Fatemi, M.D.
CMHS Medical Director of Structural Heart & High-Risk Revascularization
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Dr. Omid Fatemi specializes in interventional cardiology. He received his medical degree from the University of Virginia School of Medicine, completed his residency at Baylor College of Medicine in Texas and his fellowship at Georgetown/Washington Hospital Center in Washington DC. He is a member of the American Heart Association, American College of Cardiology and Society for Cardiovascular Angiography and Interventions.

What is Structural Heart?
Structural Heart refers to the diagnosis and treatment of defects and diseases affecting the physical structure of the heart.  Structural Heart procedures include valve repair and replacement, left atrial appendage occlusion, heart failure interventional device therapies, and the closure of ASDs, and PFOs.

What is Aortic Stenosis? Play video

Aortic stenosis (AS) is one of the most common and most serious valve disease problems1

With AS, the opening of the aortic heart valve narrows. As a result, the heart needs to work harder and may not pump enough oxygen-rich blood to the body.2
Approximately 2.5 million people in the U.S. 75 years or older suffer from AS.3

What causes Aortic Stenosis? Play video

Without treatment, severe symptomatic AS is life-threatening5

After the onset of symptoms, patients with severe AS have a survival rate as low as 50% at 2 years and 20% at 5 years without aortic valve replacement.6
Traditional treatment for this disease is open-heart surgery, which may require extensive hospital stays and recovery times.7

Why Go Through Open Heart Surgery When There’s a Less Invasive Option?

The impact of TAVR today

Short length of hospital stay.**

**The PARTNER II S3i trial, SAPIEN 3 Valve, unadjusted procedural factors (AT)

The survival rate at 30 days for patients at intermediate-risk of open-heart surgery who received the SAPIEN 3 valve.***

***The PARTNER II trial intermediate-risk cohort 30-day unadjusted clinical event rates for TAVR with the SAPIEN 3 valve, AT population (n=1077)

Valves in the SAPIEN family are implanted in more patients worldwide than any other transcatheter heart valve.

Evelyn’s Winning Attitude Towards Life Is Renewed Play video

What Happens During a TAVR Procedure?

Transfemoral Approach Diagram

Since FDA approval in 2011, TAVR has opened a new door of possibilities and options for treating people with severe aortic stenosis.

What makes TAVR different from open heart surgery is that it uses a less invasive approach to treat a diseased aortic valve. A TAVR Doctor will determine the best approach for replacing your valve, but the most common technique involves a small incision made in the leg. This is called the transfemoral approach.

In the transfemoral approach, your TAVR Doctor will make a small incision in your leg and a catheter will be inserted into your artery while your heart is still beating. Your TAVR Doctor will then guide the catheter up to your heart and will replace the valve within your diseased aortic valve. Learn more about what to expect during the TAVR procedure.

Play video

The Community Memorial Hospital TAVR team can walk you through the procedure and determine if TAVR is right for you.

To learn more about TAVR at Community Memorial Hospital, please contact our Structural Heart Coordinator, Erin Carlander, MSN, RN at 805-948-5665.

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TAVR Team

Legal Info:

Edwards SAPIEN 3 THV System and Edwards SAPIEN 3 Ultra THV System

Indications:

The Edwards SAPIEN 3 Transcatheter Heart Valve System and Edwards SAPIEN 3 Ultra Transcatheter Heart Valve System are indicated for relief of aortic stenosis in patients with symptomatic heart disease due to severe native calcific aortic stenosis who are judged by a Heart Team, including a cardiac surgeon, to be appropriate for the transcatheter heart valve replacement therapy.

The Edwards SAPIEN 3 Transcatheter Heart Valve System and Edwards SAPIEN 3 Ultra Transcatheter Heart Valve System are indicated for patients with symptomatic heart disease due to failure (stenosed, insufficient, or combined) of a surgical bioprosthetic aortic or mitral valve who are judged by a heart team, including a cardiac surgeon, to be at high or greater risk for open surgical therapy (i.e., predicted risk of surgical mortality ≥ 8% at 30 days, based on the STS risk score and other clinical co-morbidities unmeasured by the STS risk calculator).

Contraindications:

The valves and delivery systems are contraindicated in patients who cannot tolerate an anticoagulation/antiplatelet regimen or who have active bacterial endocarditis or other active infections.

Warnings:

Observation of the pacing lead throughout the procedure is essential to avoid the potential risk of pacing lead perforation. There may be an increased risk of stroke in transcatheter aortic valve replacement procedures, as compared to balloon aortic valvuloplasty or other standard treatments in high or greater risk patients. Incorrect sizing of the valve may lead to paravalvular leak, migration, embolization, residual gradient (patient-prosthesis mismatch), and/or annular rupture. Accelerated deterioration of the valve due to calcific degeneration may occur in children, adolescents, or young adults and in patients with an altered calcium metabolism. Prior to delivery, the valve must remain hydrated at all times and cannot be exposed to solutions other than its shipping storage solution and sterile physiologic rinsing solution. Valve leaflets mishandled or damaged during any part of the procedure will require replacement of the valve. Caution should be exercised in implanting a valve in patients with clinically significant coronary artery disease. Patients with pre-existing bioprostheses should be carefully assessed prior to implantation of the valve to ensure proper valve positioning and deployment. Do not use the valve if the tamper-evident seal is broken, the storage solution does not completely cover the valve, the temperature indicator has been activated, the valve is damaged, or the expiration date has elapsed. Do not mishandle the delivery system or use it if the packaging or any components are not sterile, have been opened or are damaged (e.g., kinked or stretched), or if the expiration date has elapsed. Use of excessive contrast media may lead to renal failure. Measure the patient’s creatinine level prior to the procedure. Contrast media usage should be monitored. Patient injury could occur if the delivery system is not un-flexed prior to removal. Care should be exercised in patients with hypersensitivities to cobalt, nickel, chromium, molybdenum, titanium, manganese, silicon, and/or polymeric materials. The procedure should be conducted under fluoroscopic guidance. Some fluoroscopically guided procedures are associated with a risk of radiation injury to the skin. These injuries may be painful, disfiguring, and long-lasting. Valve recipients should be maintained on anticoagulant/antiplatelet therapy, except when contraindicated, as determined by their physician. This device has not been tested for use without anticoagulation. Do not add or apply antibiotics to the storage solution, rinse solution, or to the valve. Balloon valvuloplasty should be avoided in the treatment of failing bioprostheses as this may result in embolization of bioprosthesis material and mechanical disruption of the valve leaflets. Failure to use slow, controlled inflation and prescribed nominal inflation volumes may result in balloon rupture, and lead to patient death or serious injuries associated with difficulty retrieving the delivery system and surgical intervention.

Precautions:

Long-term durability has not been established for the valve. Regular medical follow-up is advised to evaluate valve performance. Limited clinical data are available for transcatheter aortic valve replacement in patients with a congenital bicuspid aortic valve who are deemed to be at low surgical risk. Anatomical characteristics should be considered when using the valve in this population. In addition, patient age should be considered as long-term durability of the valve has not been established. Glutaraldehyde may cause irritation of the skin, eyes, nose, and throat. Avoid prolonged or repeated exposure to, or breathing of, the solution. Use only with adequate ventilation. If skin contact occurs, immediately flush the affected area with water; in the event of contact with eyes, seek immediate medical attention. For more information about glutaraldehyde exposure, refer to the Safety Data Sheet available from Edwards Lifesciences. To maintain proper valve leaflet coaptation, do not overinflate the deployment balloon. Appropriate antibiotic prophylaxis is recommended post-procedure in patients at risk for prosthetic valve infection and endocarditis. Additional precautions for transseptal replacement of a failed mitral valve bioprosthesis include, the presence of devices or thrombus or other abnormalities in the caval vein precluding safe transvenous femoral access for transseptal approach; and the presence of an Atrial Septal Occluder Device or calcium or abnormalities in the atrial septum preventing safe transseptal access. Special care must be exercised in mitral valve replacement if chordal preservation techniques were used in the primary implantation to avoid entrapment of the subvalvular apparatus. Safety and effectiveness have not been established for patients with the following characteristics/comorbidities: non-calcified aortic annulus; severe ventricular dysfunction with ejection fraction < 20%; congenital unicuspid aortic valve; pre-existing prosthetic ring in any position; severe mitral annular calcification (MAC); severe (> 3+) mitral insufficiency, or Gorlin syndrome; blood dyscrasias defined as leukopenia (WBC < 3000 cells/mL), acute anemia (Hb < 9 g/dL), thrombocytopenia (platelet count

Potential Adverse Events:

Potential risks associated with the overall procedure, including potential access complications associated with standard cardiac catheterization, balloon valvuloplasty, the potential risks of conscious sedation and/or general anesthesia, and the use of angiography: death; stroke/transient ischemic attack, clusters, or neurological deficit; paralysis; permanent disability; respiratory insufficiency or respiratory failure; hemorrhage requiring transfusion or intervention; cardiovascular injury including perforation or dissection of vessels, ventricle, atrium, septum, myocardium, or valvular structures that may require intervention; pericardial effusion or cardiac tamponade; thoracic bleeding; embolization including air, calcific valve material, or thrombus; infection including septicemia and endocarditis; heart failure; myocardial infarction; renal insufficiency or renal failure; conduction system defect which may require a permanent pacemaker; arrhythmia; retroperitoneal bleed; arteriovenous (AV) fistula or pseudoaneurysm; reoperation; ischemia or nerve injury or brachial plexus injury; restenosis; pulmonary edema; pleural effusion; bleeding; anemia; abnormal lab values (including electrolyte imbalance); hypertension or hypotension; allergic reaction to anesthesia, contrast media, or device materials; hematoma; syncope; pain or changes at the access site; exercise intolerance or weakness; inflammation; angina; heart murmur; and fever. Additional potential risks associated with the use of the valve, delivery system, and/or accessories include: cardiac arrest; cardiogenic shock; emergency cardiac surgery; cardiac failure or low cardiac output; coronary flow obstruction/transvalvular flow disturbance; device thrombosis requiring intervention; valve thrombosis; device embolization; device migration or malposition requiring intervention; left ventricular outflow tract obstruction; valve deployment in unintended location; valve stenosis; structural valve deterioration (wear, fracture, calcification, leaflet tear/tearing from the stent posts, leaflet retraction, suture line disruption of components of a prosthetic valve, thickening, stenosis); device degeneration; paravalvular or transvalvular leak; valve regurgitation; hemolysis; device explants; nonstructural dysfunction; mechanical failure of delivery system and/or accessories; and non-emergent reoperation.