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Health Matters: Providence Saint Joseph Medical Center | 9 Robert J. Gottner, MD, chairman, cardiac thoracic surgery, Prabhdeep Sandhu, MD and Sachin Navare, interventional cardiologists. W hen the aortic valve in your heart cannot function properly due to a buildup of calcium, your risk of heart failure increases dramatically. This condition, aortic stenosis, hinders blood from flowing easily through your body, forcing your heart to work harder. In the past, open-heart surgery was the only way to replace the aortic valve. But at Providence Saint Joseph Medical Center, we offer a minimally invasive procedure for aortic valve replacement called transcatheter aortic valve replacement (TAVR). Prabhdeep Sandhu, MD, an interventional cardiologist and director of the Cardiac Catheterization Lab at Providence Saint Joseph, explains, "This is a well-established way of treating aortic stenosis. We have been taking patients that need this minimally invasive procedure to other hospitals, but in November we started doing the procedure here." UNLIKE OPEN-HEART SURGERY, TAVR DOES NOT REQUIRE SURGEONS TO OPEN THE CHEST Through a small incision in the thigh or groin, a thin, narrow catheter guides the new aortic valve to the heart. "Ninety-five percent of this procedure is accomplished through accessing blood vessels in the groin. Unlike open surgery, this procedure is much easier for patients to recover from," adds Dr. Sandhu. "Usually they leave the hospital in 48 hours, rather than four to six days with open surgery. And there is a much shorter recovery period at home as well." Dr. Sandhu explains how the decision is made to do TAVR or open surgery: "First we do a CT scan to see the blood vessels and other factors, and based on that we make the decision. While it used to be used mostly for high-risk patients who couldn't endure open-heart surgery, the criteria have changed. "We are now using this for low- and intermediate-risk patients as well," notes Dr. Sandhu. "We used to use surgical risk as a tool to determine who we should treat with TAVR; now we use the patient's anatomy and comorbidity. We might even opt to do an open surgery on a younger person." We have a team approach: The cardiac thoracic surgeon, imaging department, interventional cardiologist and nurses all decide which approach to take. "We will definitely see a shift towards TAVR and away from other surgical options," Dr. Sadhu says. "We hope that local physicians will get the word out that we are doing this procedure here and think that we probably do 20 to 35 TAVR procedures a year." TAVR: A Better Way to Treat Aortic Stenosis

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