Physicians at the Washington University and Barnes-Jewish Heart & Vascular Center have extensive experience and expertise evaluating and treating people who may need transcatheter aortic valve replacement (TAVR). As members of the PARTNER (Placement of AoRtic TraNscathetER Valves) Trial, which involved 23 North American research institutions in developing and testing the procedure, our physicians are among the pioneers of TAVR worldwide.
Once patients uh qualify for a trans cater valve procedure, the first step is to select the right access point. The majority of the patients now have their procedure performed through the femoral artery or the artery that feeds the leg. But if that one is too small or does not provide an appropriate conduit, we could either do it through the collar bone on the left side or potentially making a small incision in the front of the chest. We then go ahead and use a guide wire to cross the diseased valve. We use the guide wire as a railing system that will help push the uh the catheter delivery system to where it needs to go. The new valve is mounted inside a stent or a frame that is advanced through a catheter onto the aortic valve position. Once the position is confirmed by X ray and or ultrasound, we then go ahead and deploy the valve either by inflating a balloon or releasing the um the outer component of the valve. So then it anchors into where the old valve is. We take the old valve that is diseased and use it to anchor the new valve, so it stays in place. The valve now begins to work immediately after it's deployed and the patients do not need to be on the heart lung machine patient that uh requires evaluation from our valve from our valve team of physicians which may include either aortic stenosis, my regurgitation or any other sort of valve abnormality that may be considered higher risk or complex. It's as easy as calling our valve help line after the call is taken and the data is uh is obtained and contact information is obtained. Uh We obtain records and then we try to have the patients come to one of our two centers a within two weeks of uh of having all of the the data gathered. If we feel that uh before the, the patient can be offered a a office visit, that they're too sick to wait for an office visit, then we can facilitate the transfer from outside institutions into our institutions. So we can expedite the treatment and the evaluation process. When we evaluate patients, we don't just evaluate a patient for, for TAVR procedure, but we evaluate a patient and then are able to decide what type of procedure these patients will be best suited with. So it's not uncommon for patients to come for a particular for, with a particular idea in mind um via the cater valve replacement and end up having something different because of the other characteristics that we've been able to uh discover in the evaluation process. Each patient is different. And there are certain characteristics that we look for on the aorta, the aortic valve and the heart per se. Uh in order to know which valve will sit better in their, depending on their anatomy, the valves that we have available come in four different sizes. And as a result, we need to make sure that the sizes are chosen well in relation to what the complex of the aorta the heart look like. We may encounter patients who need a very large valve that we may not have available from a catheter perspective. Or on the other hand, we may have uh patients who have a lot of calcification underneath the valve that may prevent an appropriate seal or have a lot more leakage on what would be expected. And those are patients, we normally do not recommend to have a cathe valve procedure. If there is a a safe alternative, uh or potentially if the arteries that feed the heart are too close to where the frame of the valve sits, then uh these are patients who normally we would not recommend to have a tower unless the other options are not safe. Patients would qualify if they're of intermediate high or extreme surgical risk. You can qualify for procedure if you're low risk only if uh you enroll in a clinical trial. Trans cat valve replacement has not been studied as exhaustively in patients who have bicuspid valve or in patients who have uh aortic insufficiency. This is a treatment only for aortic stenosis. The physicians at Barnes Church Hospital and Washington University School of Medicine have been actively involved in um the trans cathe aortic valve replacement uh trials since their inception were one of the 1st 10 sites that were considered um for the, the partner one trial, which is the first uh trial that evaluated patients for this type of technology. Um That trial, he evaluated patients with a first generation valve called the Sapient Valve. And with it, with the results of that were obtained from that clinical trial. It we were able to prove that in patients who are not surgical candidates, trans cathe valve replacement is better option than medical therapy. And in the high risk patients, trans cater valve replacement is non inferior to surgery.
