MDNews - Mid Hudson

A Thoughtful Path to TAVR GE T TING A TR A NSCATHE TER aortic valve replacement (TAVR) program off the ground requires the support of a variety of stakeholders, physician expertise, a suitable patient popula - tion and specific clinical infrastructure. Vassar Brothers Medical Center spent more than a year developing and refining these elements and ensuring they were in place before debut - ing TAVR at the Medical Center in January 2016. "We considered TAVR for a while before deciding we should offer it at Vassar Brothers Medical Center," says Daniel O'Dea, MD, FACC, Vice President of Cardiovascular Services at Health Quest and Vassar Brothers Medical Center. "We take patient safety seriously and wanted to be sure we could provide the range of services that individuals with critical aortic stenosis need." One of the most important steps in the process was ensuring the multidisciplinary team that would perform TAVR spent ample time learning the procedure. The entire group — interventional cardiologists, surgeons, nurses, physician assistants, medical assistants and cardiac catheterization laboratory assistants — spent months training at Albany Medical Center. M. Zubair Jafar, MD, FACC, Director of Interventional Cardiology and the Cardiac Catheterization Laboratory at Vassar Brothers Medical Center, and Mohan Sarabu, MD, FACS, FACC, Director of Cardiothoracic Surgery at Vassar Brothers Medical Center, are the two clinicians who perform TAVR at Vassar Brothers Medical Center. The pair completed more than 100 TAVR cases at Albany Medical Center in 14 months prior to introducing the procedure at Vassar Brothers Medical Center. "That is unusual," Dr. Jafar says. "Most centers start TAVR programs from scratch in place, but Dr. Sarabu and I had been doing the procedure at another facility for many months before performing our first case at Vassar Brothers Medical Center. That extra experience was invaluable." The team's extensive training is just one example of how Vassar Brothers Medical Center prioritizes patient safety in performing TAVR. "We brought in outside experts to proctor many of our ini- tial cases and advise the team," Dr. O'Dea says. "We provide all of our TAVR data to New York state. Our quality review protocol ensures we scrutinize every step of the process, from initial intake to recovery. All cases are reviewed in a multidisciplinary fashion by clinicians who are not involved in the process, to ensure objectivity." The result of this careful, deliberate approach and atten- tion to detail is a TAVR program that is well-positioned to grow and adapt with the structural heart field. "New transcatheter techniques for replacing mitral valves and combining mitral valve and aortic valve replace- ment are emerging," Dr. Sarabu says. "Our team has the skills and desire to stay on the leading edge of valve dis- ease treatment." disease using echocardiography. If an echocardiogram reveals critical disease, referral to the Vassar Brothers Medical Center Valve Clinic for valve replacement evaluation is warranted. "Most individuals are candidates for SAVR, but a subset who are elderly and have comorbidities that may include frailty, inability to walk, oxygen depen- dence, history of stroke, renal failure, chronic obstructive pulmonary disease and previous surgeries are considered for TAVR," says Mohan Sarabu, MD, FACS, FACC, Director of Cardiothoracic Surgery at Vassar Brothers Medical Center. "In these individuals, critical aortic stenosis is typically characterized by a valve area of less than one square centimeter, a peak aortic-jet velocity of more than four meters per second and a gradient of more than 40 millimeters of mercury across the valve." RIGOROUS EVALUATION At the Vassar Brothers Medical Center Va lve Clinic, Gera ldine Kenny, the Valve Clinic Coordinator, arranges an initial round of testing for patients, which typically includes an echocardiogram to assess the extent of valve disease and a CT scan of the chest to view surrounding anatomy so clinicians can evaluate the viability of using various transcatheter access techniques. During the appoint- ment, patients also undergo a functional capacity test to assess their walking ability and a mental capacity test to detect and evaluate dementia. Additionally, patients have a frailty index test and meet with an interventional cardiologist and two cardiothoracic surgeons. PHOTO © M ROCK PRODUCTIONS Simon Gorwara, MD, Dr. Jafar and Dr. Sarabu evaluate valve placement in a TAVR patient. M D N E W S . C O M /// M D N E W S M I D H U D S O N ■ 2 016 0 7

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