MultiCare’s Pulse Heart Institute performed its first transcatheter aortic valve replacement (TAVR) in 2014. TAVR, a minimally invasive procedure to replace a diseased aortic valve, alleviates the symptoms of aortic stenosis and is an option for all patients with suitable anatomy. Pulse was the first healthcare system in the South Sound to offer this procedure and is now the first in the South Sound to offer transcarotid TAVR.
What is TAVR?
TAVR typically uses a small incision in the upper leg to deliver a new valve through the iliac and femoral arteries into the to aorta and eventually to the heart, where the old disease valve is pushed aside. For many patients, this can avoid the more substantial recovery associated with open-heart surgery.
Alternative Access and Transcarotid TAVR
In some cases, insertion through the leg is not feasible due to small or diseased femoral or iliac arteries. For these patients to successfully undergo TAVR, the valve classically has been delivered through an incision in the chest or shoulder that — while smaller than the incision required for an open-heart valve replacement — still requires substantially more recovery than the standard technique.
Led primarily by two centers in the country – Saint Vincent’s in Portland, Oregon, and Yale University in New Haven, Connecticut – abundant data has shown that using the common carotid artery has been associated with lower risks of stroke and faster procedural and recovery times than other alternative access points. The common carotid artery is accessed by a small incision located low on the neck.
PSR TAVR Program Implements Change
Spurred by this data, many large centers across the country have adopted carotid as their primary alternative access point. At a PSR Structural COE meeting earlier this year, the development of a transcarotid access workflow was approved.
“In addition to the clinical benefits to the patient, I am particularly optimistic about this technique because it eliminates several weeks of workup leading up to the procedure, which can be a stressful time for our patients for whom anxiety lies in waiting.” explains PSR Structural Heart COE Physician Director Prashant Atri, MD. “Carotid access is safer, faster and cheaper than other alternative access points in a landscape where the need for alternative access is growing quickly.”
In a field trip facilitated by Edwards Lifesciences this summer, members of the Pulse Valve team from the PSR traveled to Saint Vincents in Portland and were graciously hosted there for a day of observation.
Earlier this month, Dr. Mumme, Dr. Vora, Dr. Carlson and the Tacoma General Cath Lab and OR Team performed the first transcarotid TAVR at Pulse Heart Institute. The patient recovered well and was discharged home without complication.
Congratulations to everyone involved in this exciting advancement in the treatment of aortic stenosis, making it safer and more efficient for our patients.
For more information about Pulse Heart Institute and its programs, visit the Pulse website or call:
Inland Northwest 509-755-5500
Puget Sound Region 253-572-7320