TAVR

Transcatheter Aortic Valve Replacement (TAVR) refers to a minimally invasive procedure used to replace the aortic valve.

TAVR refers to Transcatheter Aortic Valve Replacement, a minimally invasive method to replace the aortic valve. The TAVR program at St. Joseph Hospital is one of the highest volume programs in Orange County, performing around 180 successful procedures each year. Dr. Aidan R. Raney received expert training in TAVR during a 2-year fellowship at the prestigious Scripps Clinic in San Diego. He performed the first TAVR at St. Joseph Hospital in 2016. Dr. Eugene Byun joined Dr. Raney shortly thereafter, and together the physicians perform over 200 valve procedures per year. In response to high volume, Dr. Raney and Dr. Byun started performing TAVR procedures at St. Jude Medical Center in late 2019.

Why choose our physicians for your TAVR procedure?

• Outcomes at St. Joseph and St. Jude hospital consistently rank in the top 10% nationally
• Our physicians perform the highest volume of cases in Orange County, leading to the best outcomes
• We are a recognized national training site for TAVR program and procedure optimization
• We are involved in cutting edge clinical trials
• We use a “minimalist” strategy where over 90% of our procedures are performed with sedation instead of general anesthesia. This leads to quicker recovery times, and most patients are discharged 1 day after the procedure

Why does the aortic valve need to be replaced?

As the heart muscle ages, the aortic valve can develop wear and tear from constant use. Calcium begins to deposit on the valve, which leads to “stenosis,” which is narrowing of the valve. When the narrowing becomes severe, the heart must work extra hard to pump blood to the brain and the rest of the body. Patients may develop symptoms including shortness of breath, chest pain, or a lack of energy when performing everyday tasks.

What are the steps prior to the procedure?

There are several tests that need to be completed prior to a TAVR procedure. Many of these tests are required by Medicare and insurance companies. The main testing includes:

• Coronary angiogram: A procedure where dye is injected into the arteries of the heart to check for major blockages. We need to make sure these arteries are clear before working on the heart valve.
• CT Angiogram: A specialized CAT scan to recreate each patient’s aortic valve; this ensures that each patient receives the right size TAVR valve.
• Consultation with cardiac surgeon: All patients will need to visit with a cardiac surgeon. Some patients may be a better candidate for open heart surgery, and all TAVR procedures are performed in conjunction with a cardiac surgeon. We collaborate with the cardiac surgeon to determine the best valve and approach.

How is the procedure performed?

Engineers developed a heart valve that can be mounted on a balloon, which allows it to be inserted into the femoral artery and advanced inside the stenotic aortic valve. Once in position, the valve is then expanded up to 5 times larger, and the new valve functions immediately.

Procedures take place in the cardiac cath lab, where we have special X ray equipment. An anesthesiologist administers deep sedation. We use sedation instead of general anesthesia as it provides a quick recovery time after the case and allows for a pain free procedure.

We start by placing a catheter (tube) into the femoral artery, which is the main artery in the leg just above the hip. Through this tube, we advance a wire and guide it across the narrowed aortic valve. With the wire in place, we insert a new heart valve inside the existing narrowed heart valve. The balloon is then expanded, leaving a new heart brand valve in place. We then remove the balloon and wire, and finish by closing the hole in the femoral artery with stitches. The procedure takes about 30-45 minutes.

What is the recovery like?

The recovery from TAVR is relatively quick, particularly when compared to alternatives such as open heart surgery. We use moderate sedation during the case, and patients are awake 15-20 minutes after the procedure. Patients are admitted to a hospital room and monitored closely. Patients will lie flat for 4-5 hours, then can sit upright in a chair. The majority of our patients are discharged after a one night observation in the hospital.

After discharge, patients can resume everyday activity, including walking. We recommend no heavy lifting for at least one week to give the artery time to heal. Bruising around the femoral artery is normal, as a small amount of blood may leak out into the soft tissue. This blood will be totally recycled, but it may take 3-4 weeks for the discoloration from bruising to resolve. It is ok to shower, but we recommend avoiding a bath until the puncture site has healed.

St. Joseph Hospital TAVR program

The TAVR program at St. Joseph Hospital is the highest volume program in Orange County, with over 600 successful procedures since 2016. Dr. Aidan R. Raney received expert training in TAVR during a 2 year fellowship at the prestigious Scripps Clinic in San Diego. He performed the first TAVR at St. Joseph Hospital in 2016. Dr. Eugene Byun joined Dr. Raney shortly thereafter, and together the physicians perform over 200 valve procedures per year. Outcomes at St. Joseph hospital consistently rank in the top 10% nationally.

St. Jude Medical Center TAVR program

Dr. Byun and Dr. Raney started the program at St. Jude Medical Center in 2019 in response to increased demand for aortic valve replacement in Orange County and the surrounding area. The team includes St. Jude’s cardiothoracic surgeon, Dr. Taylor Tang, in addition to the staff that has performed hundreds of procedures at St. Joseph’s Hospital.