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comprehensive care for complex patients "Our heart program is distinguished by our experience with therapies, including catheter-based valve procedures, for a whole new category of patients who previously didn't have many options," explains Timothy Kroshus, MD, cardiovascular and thoracic surgeon at Regions Hospital Heart Center. Regions Hospital Heart Center offers a complete surgical program that includes structural heart disease repairs, standard and minimally invasive valve repairs, and surgeries for congenital heart disease, arrhythmia and aneurysm. Additionally, the center offers comprehensive programs that monitor and follow patients through recovery. These extensive capabilities address the individual needs of each patient through a full range of state-of-the-art procedures. select patient screening maximizes outcomes The FDA has approved use of the TAVR procedure for a select group of patients. During clinical trials for the TAVR procedure, only inoperable patients were eligible. The procedure improves survival rates for this patient population, even though current data indicates the risk of stroke and other complications is greater after a TAVR procedure than it is after conventional surgery. Because the procedure is so new, no long-term data exists to evaluate long-term patient outcomes or valve durability. "If you compare a standard aortic valve replacement patient to a TAVR patient, the standard surgery patient clearly does better," explains Dr. Kroshus. "But we don't offer TAVR to patients who are appropriate for standard surgery — we offer it to a carefully screened group of higher-risk patients. Approximately two-thirds of these inoperable or highrisk patients will not survive two years without a TAVR. For this very high-risk population, TAVR decreases the risk of dying by 20 percent." Regions Hospital Heart Center evaluates potential TAVR candidates using a Society of Thoracic Surgeons risk score and direct evaluation by several cardiologists and at least two surgeons. The center's communication system is integrated so that primary care physicians, hospitalists and subspecialists share the same electronic health record. Evaluating physicians collect a complete picture of a patient's condition and work collaboratively to identify the surgical, transcatheter or medical management solution that will maximize the patient's outcome. These complex patients benefit from the full spectrum of resources that Regions Hospital is able to provide. "We do a comprehensive analysis, and our heart team looks at the whole patient," explains Stephen Smalley, MD, a cardiologist with Regions Hospital Heart Center. "We consider the referring physician and the patient as much a part of our team as our proceduralists." cardiac care at level i centers minimizes surgical Risks Once a patient has been screened, evaluated and approved for TAVR, the procedure is performed by a team made up of 8–10 specialty physicians, including a cardiac surgeon, cardiologist and cardiac anesthesiologist. "Results will be best if we properly select patients and treat them with a procedure that's best tailored to their individual circumstances," says Dr. Kroshus. Because TAVR patients are medically delicate, it is critically important to have a well-trained surgical team to address potential complications. If a dangerous complication arises during the PhoTo © DAviD GiNsbeRG Following FDA approval, Regions Hospital Heart Center, part of the HealthPartners Family of Care, was one of only three Minnesota sites — and the only site in Saint Paul — originally selected to offer the procedure. Because the TAVR procedure is complex, hospital applicants had to meet rigorous standards for approval. Heart programs were evaluated based on surgical and coronary intervention volumes, surgical quality and outcomes, and the expertise of surgeons in vascular and structural heart disease. Rochus voeller, MD, prepares to open the femoral artery access to place the TAvR device. procedure, the team has the expertise to take care of the issue on the spot and without delay. Following surgery, the cardiovascular surgery ICU service manages patient recovery. The heart team at Regions is distinguished by its depth of experience in valve repair. Members of the surgical team have performed thousands of valve interventions and aortic surgeries. The cardiac outcomes at Regions reflect the team's expertise. In 2011, the Regions Hospital Heart Center's mortality rate was zero, and Dr. Kroshus' valve procedure mortality rate was zero in both 2011 and 2012. "You have to be an expert in valve diseases and procedures to take on a new procedure such as TAVR," explains Dr. Kroshus. enhanced procedural accuracy The TAVR catheter can be threaded to the aortic valve through the femoral artery or through apical access. Going through the groin is much less invasive. Patients are up shortly afterward and are mDnews.com ■ MD News Twin Cities |7

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