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The University of Arizona and the Sarver Heart Center are working to provide patients of Southern Arizona the latest advancements in life-saving, non-invasive heart procedure techniques, including the transcatheter aortic valve replacement, or TAVR program.
The University of Arizona Medical Center is the first in the region to be approved to perform the TAVR procedure, which is ideal for patients who, for health reasons, aren’t eligible for open-heart surgery or are at high risk of death or serious complications from open-heart surgery, according to the UA Department of Surgery website and Dr. Kapil Lotun, MD, who was recruited in August 2011 to start the TAVR program at UA.
TAVR uses a procedure that is not unlike balloon angioplasty and coronary stenting, wherein a TAVR device is compressed and attached to a balloon device that is inserted through the groin. The device is pushed through the aortic valve and the balloon is inflated to expand the replacement valve. The balloon then deflates, leaving the new valve securely in place and allowing blood to flow to the heart.
Lotun said that the TAVR technique is beneficial for high-risk patients because it’s less painful and cuts down the length of hospital stays as well as recovery time compared to the more invasive open-heart surgery.
High-risk patients are those with lung problems, kidney problems, liver disease, pulmonary hypertension, the elderly or those on dialysis, who are more likely to die or become dependent on pacemakers or breathing machines as a result of open-heart surgery, according to Dr. Lotun.
Lotun also said that this week was the first case where he and his team were able to do the TAVR procedure by accessing the heart directly through a small incision in the chest wall, rather than going up through the groin.
“We are the first ones in the city of Tucson to do it,” Lotun said, adding there are between 100 and 120 other medical centers in the country that are performing these new valve procedures.
Currently, the TAVR procedure involves fibrillating the heart by placing a wire on the right side of the heart and accelerating it to 180 to 200 beats per minute, which causes the heart and the flow of blood to stop.
But Dr. Lotun said there are new valves coming into the market that he hopes to get by the end of the year that will not require fibrillating or stopping the heart to be put into place, thus reducing patients’ ultimate risk.
Lotun and his team are currently doing trial cases to see if low-risk patients are also good candidates for the TAVR procedure. He said the longest these valves have been in place so far is eight years, so until they gather more data, they are unsure of the valves’ and the TAVR procedure’s durability over the long term.
As of right now, Lotun said open-heart surgery is still the main method of treatment among low risk patients, which involves the patient being put under anesthesia, the surgeon opening the chest cavity to access the heart directly, putting in a bypass machine and physically replacing the valves by hand.
In addition to the TAVR procedure, Dr. Lotun is working to advance cardiac catheterization procedures by going in from the forearm rather than the groin. By going in through a small incision in the arm, patients greatly reduce their risk of bleeding and hematoma, which Lotun said “can be devastating and lead to high risk of death.” Additionally, this new technique allows patients to get up right away, allowing them to get food, walk around and act normally.
Yet another technique Dr. Lotun is helping to advance is that of paravalvular leak closure. This procedure is for patients who have had replacement valves put in by surgery that have leakage around the valve. Lotun said this condition usually requires additional open-heart surgery, but can now be done by inserting small plugs into the leaking valves by going in through the groin.
Dr. Lotun is board certified and fellowship trained in vascular medicine, endovascular medicine, cardiology and interventional cardiology from Tufts University Medical Center in Boston. After one year in private practice, Lotun said he went into academics to become the director of the vascular medicine program at Virginia Commonwealth University before joining UA in 2011.
The UAMC is currently evaluating patients for the TAVR procedure and encourages them to call (520) 626-6358 for more information or to schedule an appointment.