Non-invasive double valve replacement procedure cuts recovery time for high-risk patients

Open-heart surgery to repair or replace valves can often be too great a risk for many patients despite the necessity of the procedure. Instead, these high-risk patients undergo a less-invasive valve-replacement procedure. Because of the delicacy of this operation, if more than one valve needs to be replaced, more than one surgery is usually required. However, this past April, Dr. Firas Zahr, from the Division of Cardiovascular Medicine, and Dr. Mohammad Bashir, a UIHC cardiothoracic surgeon, completed what they believe to be the first operation in which two valves were replaced.

The transcatheter aortic valve replacement (TAVR) entails wedging a new valve—transported to the site via catheter through the arteries—into place in the heart without removing the old valve altogether. Though TAVRs have been performed plenty of times before, Dr. Zahr and Dr. Bashir’s novel achievement lies in the successful replacement of both the aortic and mitral valves in a single procedure by entry through the femoral artery.

One of the benefits of TAVR as a non-invasive procedure is the faster recovery time, said Dr. Bashir, as well as the decreased risk for patients with particular conditions, such as those with a build-up of calcium on the mitral valve called mitral annular calcification, which causes complications in tissue healing after open-heart surgery.

“It is a new hope for patients who are not surgical candidates,” said Dr. Zahr. “Obviously it is not for everyone—the technology is limited in terms of treating mitral disease—but those innovative ideas about how to use a valve that is designed to be in the aortic position and using it in the mitral position might provide some hope for patients who have no other options.”

The collaboration of Dr. Zahr and Dr. Bashir was integral in providing that new hope, as they brought together the specializations of cardiology and cardiothoracic surgery standard in TAVR procedures. “We pretty much complete each other,” Dr. Zahr said. “We plan the procedure together, we discuss the risks of the patient together, we plan our strategy together, and the procedure required both of our skills.”

Not without challenges, developing the approach took a lot of creativity. Since other researchers have not written too prolifically on replacement of the mitral valve, much of the research was up to the team. “What sort of equipment you need, what sort of angle to place your camera at, what size valve to use, and how to deploy it. All these are the challenges that we faced during our case, and we had to be a little bit innovative regarding how to deal with all of these issues,” said Dr. Bashir. Assisting with the medical imaging required for the procedure was Dr. Gardar Sigurdsson, Clinical Assistant Professor in both the Division of Cardiovascular Medicine and the Department of Radiology.

Though more research needs to be done on the long-term outcomes of the procedure before it is adopted as a universal standard for low-risk patients, Dr. Bashir said current five-year outcomes for TAVRs “look very promising.”

Dr. Zahr and Dr. Bashir presented the team’s procedure at the Transcatheter Valve Therapy conference sponsored by the Cardiovascular Research Foundation this June in Chicago, where it was well-received by representatives and researchers from medical centers throughout the country. The two are currently working on publishing their work, and are hopeful of performing the procedure more in the future.