TAVR is a treatment option for patients with a condition called aortic stenosis, which is narrowing of one of the valves on the left side of the heart. If severe aortic stenosis is left untreated, it can lead to heart failure. Replacement of the valve can be done by open heart surgery or minimally invasive TAVR.
Initially, TAVR was reserved for only the riskiest of patients who would not be able to undergo surgery, but after a series of trials, they’ve started including lower-risk patients.
TAVR works by inserting a catheter through an artery in a patient’s groin, arm, shoulder or neck. It is then guided through the blood vessels to the heart and into the aortic valve where the new valve is positioned and expanded. Recovery from the procedure is relatively short, with many patients going home the next day. Most patients feel better almost immediately and recover within the next week or two.
For Earl Berry of north St. Louis, the Christian Hospital heart team performed a TAVR in TAVR procedure, which is when a transcatheter valve replacement is done inside of a previously implanted transcatheter valve that is no longer functioning properly. “I went to see Washington University cardiothoracic surgeon, Dr. Ray, and talked to him and Andy about the procedure, and they even showed me a mockup of the valve they were going to use and where it would go.
"I was a little bit concerned because I didn’t know anybody else that had a valve inside of a valve, but each visit back to Dr. Ray’s office reassured me, as he said it was absolutely doable,” says Earl. No wonder this all seemed so new to Earl — he was one of the first patients in the St. Louis area to receive a planned (non-emergent) TAVR in TAVR, and the first to have it done by an alternative access site through the carotid artery in the neck.
Earl also lives with renal failure, which made his case even more complex. Not only did his procedure go well, but he is also now doing well. He is now able to be placed on the kidney transplant list.
“Normally, these artificial valves don’t last long in patients with renal failure. Since Earl is now eligible for a kidney transplant, his valve may last longer,” says Dr. Ray.