The TAVR Innovation: What Have We Learned?
Written By: Adam Pick, Patient Advocate & Author
Medical Expert: Dr. Allan Stewart, Chief of Cardiac Surgery, Mercy Heart Institute
Published: March 21, 2022
Transcatheter aortic valve replacement (TAVR) has been called one of the “most revolutionary technologies” in heart valve therapy. While the idea of replacing a diseased aortic valve without open-heart surgery was once criticized, TAVR has become the standard-of-care for select patients with aortic stenosis at many leading cardiac centers.
What led to the TAVR transformation? What new innovations are doctors and medical companies working on to improve patient outcomes? What should patients know about the future of aortic valve replacement?
To answer these questions, we interviewed Dr. Allan Stewart, the Chief of Cardiac Surgery at Mercy Heart Institute in Miami, Florida. During his career, Dr. Stewart has performed over 5,000 cardiac procedures and more than 2,000 heart valve operations. Within our community, Dr. Stewart has successfully treated many patients including Katherine Garcia Santos, Andrew Ludwig and Frank Sanchez.
Key Learnings About TAVR from Dr. Stewart
Here are important points from our interview with Dr. Stewart:
- According to Dr. Stewart, the top three benefits of TAVR compared to traditional aortic valve replacement are (i) no general anesthesia is required, (ii) no incision to the patient’s chest or ribs is needed, and (iii) patients may be discharged from the hospital within twenty-four hours.
- Clinical trials have been critical for the rapid utility of TAVR for inoperable, high-risk, intermediate and low-risk patients with blocked aortic valves that are calcified. In particular, the low-risk TAVR trials created a significant shift in the use of TAVR. Dr. Stewart states, “The ‘Game Changer’ was when we did the low-risk trial and we found that TAVR did even better than surgery in low-risk patients.”
- Heart teams, comprised of surgeons and cardiologists, and medical companies have implemented several innovations within TAVR devices to (i) enhance patient outcomes and (ii) reduce patient complications. Key TAVR innovations include smaller form factor, improved imaging, better implant capabilities, and new re-capture techniques. As a result, paravalvular leak following a TAVR procedure and the need for pacemakers has declined, according to Dr. Stewart.
- TAVR mortality rates at select cardiac centers is zero. Dr. Stewart states that at Mercy Heart Institute in Miami, Florida, “Our mortality rate is zero.”
- A new approach to managing aortic valve patients has emerged. Dr. Stewart states, “It bothered me in past institutions where patients who have been suffering from aortic stenosis were pretty debilitated. They’re short of breath, sometimes in a wheelchair, would have to make two or three appointments for scans or testing or labs. I wanted to make that seamless. We have created a concierge service where a patient can come see me, see my colleague in interventional cardiology, have all of their imaging done in one day, their labs drawn, their appointments scheduled, and their procedure planned, all in one office visit.”
Thanks Dr. Stewart and Mercy Heart Institute
Many thanks to Dr. Stewart and the entire team at Mercy Heart Institute in Miami, Florida for helping us learn more about TAVR. We really enjoyed visiting your new cardiac center and learning about the latest innovations and patient outcomes specific to TAVR.
Keep on tickin!
Dr. Allan Stewart: My name is Dr. Allan Stewart. I am the chief of cardiac surgery at HCA Florida. I have been in practice for 16 years. The first portion of my career was in Manhattan and now I am in Miami, Florida. During the course of my career, I have performed 5,000 open heart surgeries and have a special interest in transcatheter aortic valve surgery.
TAVR attracted me because it was one of the few things in medicine that I was involved with since its inception. In a short period of time, we moved from large devices with major complications into a very reproducible procedure that has exceeded the outcomes of surgery.
The top three benefits of TAVR over traditional aortic valve replacement are, one, no general anesthesia is required, two, no incision is required, and three, a hospital discharge the next day, and not only a hospital discharge the next day, but a complete return to function the next day.
I consider TAVR to be a “Game Changer” for the treatment of aortic stenosis. Initially, we all had patients that were very old that we said, “They’re not going to do well with the trauma of surgery. Let’s compare TAVR to them.” TAVR did better. Then we said, “Well, shoot, why don’t we look at people who are high risk?” TAVR did better in them. Then we did another study and said, “What about intermediate risk, people that will do well with surgery, but let’s compare it and see what happens?” No one expect TAVR to do better, but TAVR performed better. The gamechanger was when we did the low-risk trial and we found that TAVR did even better than surgery in low-risk patients. Then we said, “Well, geez, TAVR is the treatment of choice for aortic stenosis.” That has all been done with the holy grail of medical studies, perspective randomized trials. TAVR has won trial after trial after trial.
Some of the key developments of TAVR have been improving our imaging, meaning where do we land the valve. We can land these valves within a millimeter of where our intention is. That’s eliminated both the paravalvular leakage, which also is eliminated by a design improvement, and reduced the need for a pacemaker. We’ve changed the mechanism of delivery. We’ve reduced the size of the delivery system dramatically, almost by two thirds. We expect that we’re going to reduce it even further. We’ve allowed valves to be recaptured and then redeployed. It’s been a vast progression and rapid progression of knowledge. Most importantly, it’s been an incredible experience to collaborate with industry with cardiac imaging doctors with biostatisticians and trial design gurus to really change the field of structural heart valve disease.
At Mercy Heart, I started the TAVR program here less than a year ago. Our mortality rate is zero. We have created a concierge service where a patient can come see me, see my colleague in interventional cardiology, have all of their imaging done in one day, their labs drawn, their appointments scheduled, and their procedure planned, all in one office visit. It bothered me in past institutions where folks who have been suffering from aortic stenosis were pretty debilitated. They’re short of breath, sometimes in a wheelchair, would have to make two or three appointments for scans or testing or labs. I wanted to make that seamless. What I’m most proud of is that we’ve created a concierge service for structural heart valve disease here at the Mercy Heart Institute.