On Sept. 9, the 100th transcatheter aortic valve replacement (TAVR) procedure was performed in Via Christi Hospital St. Francis’ hybrid operating room.
The procedure brought renewed hope for an extended and improved quality of life to the patient, whose severe aortic stenosis previously would have been considered too high a risk for an open procedure.
It marked a milestone for Via Christi’s Structural Heart program, as well, and for the team of cardiologists, cardiovascular surgeons, anesthesiologists, and dedicated OR and heart catheterization lab staff who less than two years earlier had performed the region’s first TAVR procedure.
“This is so much more than the addition of a new procedure,” says Darrell Youngman, DO, Chief Medical Officer for Via Christi’s Wichita hospitals. ”It’s the development of a comprehensive, forward-looking approach to cardiovascular care.”
Sherry Hausmann, Chief Hospital Operations Officer for Via Christi Health, says the program was born of a conversation in early 2012 with community physicians.
“As we were engaged in our strategic planning, the cardiothoracic surgeons told us we needed to build a hybrid operating room and establish a structural heart program to better meet the needs of patients in Kansas long into the future,” says Hausmann. “They had confidence that we could work together and build something truly multidisciplinary.”
On Sept. 9, Via Christi Health’s Structural Heart team performed the 100th transcatheter aortic valve replacement procedure, less than two years after their first procedure.
So Via Christi and the physicians went to work on a plan to bring TAVR procedures and other emerging, life-saving structural heart procedures to the region.
Bassem Chehab, MD, was recruited to Wichita to serve as the program’s Medical Director and made regular trips from Kansas City, where he was completing his structural heart fellowship, to participate with the group in designing what today is the region’s only technologically advanced hybrid OR and structural heart program.
Less than a year later, the hybrid OR was ready for use at St. Francis, and the first TAVR was performed in October 2013.
“The administration at Via Christi created a receptive environment for multiple disciplines to give their input, all geared toward building a highly advanced hybrid OR that would meet the needs of the entire state for the next decade,” says Dr. Chehab, whose fellow TAVR team members include surgeons Sanjay Khicha, MD, and Brett Grizzell, MD, both with Wichita Surgical Specialists; cardiologist Richard Steckley, MD, Cardiovascular Consultants of Kansas; and anesthesiologist David Havey, MD.
The initial goal was to perform 20 TAVR procedures a year in the first two years of the program and eventually build to 40 a year.
From October 2013 through 2014, 44 TAVR procedures were performed, with outcomes that met or were better than the national average for post-procedure complication; 30-day and one-year mortality; and length of stay.
As of Sept. 9, 56 TAVR procedures had been performed, with nearly a quarter remaining in the 2015 calendar year.
“That’s only been possible because we’ve come together so well as a team, allowing us to become highly efficient and proficient in addressing these cases,” says Dr. Khicha.
Performing 100 TAVR procedures in less than two years places Via Christi in an elite group, according to Chris Baker, of Edwards Lifesciences, which manufactures one of the valves used by the program.
Only about one in five of the nation’s 350 TAVR programs have reached that milestone, Baker says. But more importantly, Via Christi’s outcomes also place it among the upper elite, he says, crediting that to the program’s teamwork, exceptional collaboration in patient review and screening, and focus on quality over volume.
Raising the Bar
Another contributing factor to the program’s success was the establishment of the Heart Valve Clinic at Via Christi, which serves as a centralized point for the team to gather and discuss cases as well as for patients to receive services.
“It’s that teamwork that has made all the difference,” says Dr. Grizzell, “a difference that allows patients too ill or too fragile to undergo an open procedure to still be able to benefit from aortic valve therapy and return to their lives more quickly and with a greater quality of life.”
For patients traveling in from around the state, having immediate access to a structural cardiologist and cardiovascular surgeons at one location also has proved beneficial.
“The population we see is extremely frail, so reducing the need for multiple appointments helps alleviate some of the burden of accessing care,” says Richard Allenbach, the physician assistant who serves as the clinic’s Director.
Because these procedures are less invasive, patient recovery times are faster. In fact, TAVR patients who had difficulty walking before the procedure often are seen walking the halls of the Cardiothoracic Intensive Care Unit just hours after they leave the OR. Hospital stays are much shorter than those following open-heart surgery, and patients are able to get back to everyday activities quickly. It’s not uncommon for patients who have undergone a TAVR procedure to find that they are able to return to activities they were previously unable to participate in because of their poor health.
“Most gratifying for me is seeing the patients walk back into the office after they’ve had their stenotic heart valves replaced and tell me how much better they feel and how much better their lives are as a result of the program,” says Dr. Steckley.
TAVR outcomes at Via Christi have been so successful that the Structural Heart program already is garnering national attention. That attention has led to the expansion of the Structural Heart team to include cardio electrophysiologist Dhaval Parikh, MD, and cardiologist Aziz Maksoud, MD, both with Cardiovascular Consultants of Kansas. Dr. Maksoud has been a vital part of the addition of MitraClip, a leading-edge treatment option for people with mitral valve regurgitation. Dr. Parikh is involved in the addition of Lariat left atrial appendage ligation, used for patients with atrial fibrillation in whom anticoagulation is contraindicated.
“In a relatively short period of time, we’ve already become a MitraClip center of excellence for the area,” says Dr. Chehab.
As research continues to find new ways to treat patients who have traditionally been at higher risk from cardiac conditions, Via Christi’s Structural Heart program is prepared with a team of talented physicians and the infrastructure to bring the latest in heart care to the region.
“The success of our Structural Heart program has had a halo effect as we continue our journey to becoming a center of excellence across our entire cardiovascular service line,” says Dr. Youngman.
For more information about the Heart Valve Clinic at Via Christi, call 316-268-8650.