On May 3, 97-year-old Myrtle Humble underwent transcatheter aortic valve replacement (TAVR) at Via Christi Hospital St. Francis. The procedure has brought renewed hope for patients whose hearts are failing because of severe aortic stenosis.
In doing so, Humble became the first patient to undergo the procedure at the Wichita hospital under conscious, or minimal, sedation.
“I feel good,” Humble said as she was preparing to be discharged three days later to a skilled nursing facility to further recover for a couple of weeks before returning to the senior living facility where she enjoys playing bingo and cards with friends. “I can’t even tell I had anything done.”
On May 10, 72-year-old Robert Dilli also underwent a TAVR procedure with minimal sedation at St. Francis — and then headed home after a three-day hospital stay.
Having had quintuple bypass surgery in 2009, Dilli says he didn’t want to undergo another open-heart procedure unless it was his only option.
Fortunately, it wasn’t.
Given Dilli’s prior surgery and other medical conditions, the Structural Heart team determined that TAVR with minimal sedation was his best treatment option.
“It was great knowing that dad wouldn’t have to be on a ventilator,” says Dilli’s daughter, Haley Busch, who works as a respiratory therapist at another Wichita hospital. “His oxygen stats are better than they’ve ever been, and because he’s been able to eat, he’s regaining his strength faster.”
Humble, TAVR patient No. 178, and Dilli, No. 182, are among the more than 200 patients to undergo TAVR at St. Francis since the first such procedure was performed two and half years ago in the facility’s hybrid operating room.
The initial goal was to perform 40 TAVR procedures in the first two years. Instead, Via Christi’s TAVR program has averaged double that number, with outcomes — as measured by post-procedure complications, 30-day and one-year mortality rates, and length of stay — that are better than the national average.
Going forward, the demand is expected to grow at an even faster clip as the national guidelines as to which patients are good candidates for TAVR are expected to be expanded to include younger and healthier patients.
“TAVR is no longer to be the procedure of last hope, but instead is becoming the go-to procedure for people with aortic valve disease,” says Bassem Chehab, MD, Medical Director for Via Christi’s Heart Valve Clinic and Structural Heart program, which includes a team of cardiologists, cardiovascular surgeons, anesthesiologists, and dedicated OR and heart catheterization lab staff.
“The question is changing from ‘Why TAVR?’ to ‘Why would we not do TAVR?’” Dr. Chehab says both in national forums and in Kansas as TAVR is quickly becoming a leading therapy across the entire spectrum of aortic valve disease.
“Today, we are the area’s leader in the structural heart field,” Dr. Chehab says. “Reaching the 100-TAVR milestone demonstrated our ability to safely offer the procedure with consistently good results. “Reaching 200 validates our ability to tackle complex cases with equally good and consistent outcomes.”
Establishing a Footing
The roots of Via Christi’s Structural Heart program can be traced to a conversation with community physicians in 2012. A hybrid operating room and establishment of a structural heart program was needed, they said, in order to meet the needs of Kansas patients now and in the future.
So Via Christi and the physicians collaborated on a plan to bring TAVR procedures and other emerging, lifesaving structural heart procedures to the region.
Dr. Chehab was recruited to serve as the program’s Medical Director, making 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. The first TAVR was performed Oct. 17, 2013.
Dr. Chehab credits the program’s success to the TAVR team, which includes surgeons Sanjay Khicha, MD, and Brett Grizzell, MD, both with Wichita Surgical Specialists; cardiologist Richard Steckley, MD, Cardiovascular Consultants of Kansas; and anesthesiologists David Havey, MD, and Sinisa Malinovic, MD.
His colleagues concur.
“Working as a team has allowed us to become highly efficient and proficient in performing these cases,” Dr. Khicha says.
Setting a solid foundation
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 meet and review cases as well as for patients to receive services.
On June 9, the Structural Heart team performed its 200th transcatheter aortic valve replacement, two and a half years after the first one was performed at Via Christi Hospital St. Francis.
“Having a centralized point in which to gather and discuss cases promotes teamwork, and that has made all the difference,” says Dr. Grizzell — one 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, immediate access to a structural cardiologist and cardiovascular surgeons at one location also has proved beneficial.
“The patients coming to the clinic already are short of breath and fatigued,” says Richard Allenbach, PA-C, the physician assistant who serves as the clinic’s Director. “They appreciate being relieved of the burden of multiple appointments at different practices.”
Because these procedures are less invasive, TAVR patients who had difficulty walking before the procedure often are seen walking the halls of the Cardiothoracic ICU just hours after they leave the OR. Hospital stays — already shorter than those following open-heart surgery — are becoming even shorter as minimal sedation is an option for most patients.
Many patients who have undergone TAVR have been able to return to activities they previously couldn’t take part in because of their poor health.
“It’s heartening to see them walk back into the office after TAVR and tell me how much better they feel and how much better their lives are as a result of the program,” Dr. Steckley says.
Building for the future
Within months of launching TAVR, the Structural Heart team was expanded to include cardio electrophysiologist Dhaval Parikh, MD, and cardiologist Aziz Maksoud, MD, both with Cardiovascular Consultants of Kansas.
Dr. Parikh’s involvement made it possible to offer Lariat left atrial appendage ligation as a treatment option to patients with atrial fibrillation for whom anticoagulation is contraindicated.
The addition of Dr. Maksoud allowed MitraClip to become a closer-to-home treatment option for patients with mitral valve regurgitation. As of May, more than 50 MitraClip procedures had been performed in Via Christi’s hybrid OR.
“So not only are we having great success with TAVR, which was our initial focus, but we’re developing a first-class, full-spectrum structural heart program,” says Darrell Youngman, DO, Chief Medical Officer for Via Christi’s Wichita hospitals. “That enhances our entire cardiovascular service line.”
For more information about the Heart Valve Clinic at Via Christi, call 316-268-8650.