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lead in the operation. If we are using the tra nsfemora l approach, the inter ven- tiona l cardiologist assumes the primary role a nd t he ca rdiot horacic surgeon assists. In approaches requiring a surgi- ca l incision, such as the tra nsapica l to access t he apex of t he hea r t a nd t he t ra n sa or t ic t o a ccess t he a or t a , t he ca rdiolog ist assists the surgeon." "A tr ue sense of ca ma raderie exists among our cardiologists and surgeons," says Da n iel O'Dea , M D, FACC, Vice President of Ca rdiova scula r Ser vices at Hea lth Quest a nd Va ssa r Brothers Medica l Center. " Inter ventiona l ca r- diolog ists t y pica l ly a re more sk i l led with wires a nd catheters, a nd ca rdio- thoracic surgeons genera lly a re more adept at surg ica lly accessing a r teries. A multidisciplina r y procedure such as TAV R wou ld not be possible w ithout collaboration a nd colleg ia lit y." O n c e t h e c l i n i c i a n a c c e s s e s t h e disea sed va lve, he adva nces the cath- eter across the structure a nd puts the prosthetic va lve in place. A dedicated echoca rdiog rapher per forms a tra ns- esopha gea l echoca rdiog ra m to g uide deployment. W hen the va lve expa nds, it pu s he s t he n a t ive le a f le t s a s ide a nd restores proper blood f low. The procedure va r ies in leng t h ba sed on approach — the tra nsfemora l version ca n ta ke as little as one hour, a nd other forms of the procedure may ta ke two to three hours. TRANSFORMATIVE RESULTS Ind iv idua ls who have t ra n sfemora l TAV R t y pica l ly leave t he hospita l in t wo or t h re e d ay s . T hose who h ave o t her for m s of t he pr o c e du r e m a y require four to seven days of recover y before discha rge. "Patients' underlying conditions have sig nif ica nt bea ring on their leng th of stay, as well," Dr. Sa rabu says. " W hen individua ls have multiple comorbidi- ties, they may need more time in the hospital. By the time patients leave the hospital, they are ambulating and are fairly independent. Transfemoral patients can resume full activities within two weeks. Those who have alternate approaches usually need to wait about three weeks." Clinicians at Vassar Brothers Medical Center performed 10 TAVR procedures during the first quarter of 2016, with great success. " Deploy ment of the va lve ha s gone p e r fe c t l y i n e v e r y p a t i e nt s o f a r," Dr. O'Dea says. " T he feedba ck f rom patients, fa mi lies a nd sta f f ha s been g reat , a nd our resu lts have been tre- mendous. We do not ta ke this success for granted. We review each case imme- diately a f ter its conclusion to identif y a reas in which we ca n improve." Dr. Ja fa r appreciates TAV R for its abilit y to restore qua lit y of life. "In the past, the only option for, say, a functiona l 80-yea r-old patient with strong menta l capacity who has critica l aor tic stenosis was death or a cycle of multiple hospita l admissions," he says. "Patients like this of ten present to the hospita l with pulmonar y edema — liter- a lly drowning in their own f luid — a nd CHF. That is a horrible way to live. Now, af ter having TAV R , ma ny of these indi- vidua ls a re mobile, active a nd able to lead hea lthy lives. The impor ta nt thing about TAV R is it en ha nces qua lit y as well as length of life. No one is too old or too sick to have this procedure." The TAVR leadership team: Geraldine Kenny, RN, Valve Clinic Coordinator; Simon Gorwara, MD; Peter Zakow, MD; Mohan Sarabu, MD; and M. Zubair Jafar, MD PHOTO © PAUL MOORE, PAUL MOORE STUDIO Nurse Svetlana Cohen checks a patient in the cardiothoracic step down unit at Vassar Brothers Medical Center. PHOTO © PAUL MOORE, PAUL MOORE STUDIO 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 9