MDNews - San Antonio

aortic stenosis who are not considered appropriate candidates for an open valve replacement procedure. According to interventional cardi- ologist Steven R. Bailey, M.D., the TAVR procedure offers a unique avenue to not only drastically reduce the effects of patients' disease, but also improve their quality of life. Dr. Bailey is Division Chief for Cardiology at UT Medicine and runs the Valve Clinic and TAVR program at University Hospital. "In this group of patients, the risk of their dying is one in two in the year after they present. Just as important, these are patients who typically are not able to carry on any kind of normal life. They get short of breath or they get chest discomfort during routine daily activities. They just don't do well," says Dr. Bailey. "There isn't anything we can do for them in terms of medical management, but with this procedure, the majority will go from very limited function to only a small limit in function." In the Right Hands Thanks to its close association with the academic medical practice UT Medicine San Antonio, University Health System is able to remain on the cutting edge of medical techniques, including those related to heart care. Specialists at University Health System have already performed two successful TAVR pro- cedures — an impressive number, as University Health System is one of the few health care systems in the country to offer the technology and the only provider in South Texas performing the procedure. A.J. Carpenter, M.D., Ph.D., Director of Cardiothoracic Surgery at University Health System, explains that the FDA approval of the SAPIEN transcatheter heart valve carried certain requirements for the facilities at which the technology was to be incorporated in patient care. Each site needs to have strong, established relationships between interventional car- diologists and cardiothoracic surgeons, all of whom must have experience THE CERTIFIED TAVR TEAM THE DEDICATED TEAM of UT Medicine San Antonio specialists performing the transcatheter aortic valve replacement at University Health System consists of inter- ventional cardiologists and cardiothoracic surgeons working in concert to deliver advanced technology. + Steven R. Bailey, M.D., FSCAI, FACC, FACP, interventional cardiologist: In active practice since 1983, Dr. Bailey is triple board-certified in cardiovascular diseases, interventional cardiology and internal medicine. His practice focuses on cardiovascular disease and congenital and structural heart defects. + A.J. Carpenter, M.D., Ph.D., cardiothoracic surgeon: Double board-certified in surgery and thoracic surgery, Dr. Carpenter completed a residency at the U.S. Air Force School of Aerospace Medicine. She has concentrated on cardiothoracic surgery and thoracic disease since beginning her medical career in 1997. + Marvin H. Eng, M.D., interventional cardiologist: Dr. Eng earned his medical degree at Wayne State University School of Medicine and went on to a fellowship at the University of Colorado Health Sciences Center and Scripps Clinic Torrey Pines. In practice since 2002, he cares for congenital and structural heart defects. + Edward Sako, M.D., Ph.D., cardiothoracic surgeon: In active practice since 1994, Dr. Sako is double board-certified in surgery and thoracic surgery. He joins Dr. Carpenter in caring for patients with thoracic diseases and offering cardiothoracic surgery. treating structural heart disease. The procedure used to put the valve in place also requires a hybrid operating room — a cardiac catheterization laboratory outfit- ted with the imaging equipment needed to guide transcatheter procedures as well as the equipment needed to perform open cardiac surgery. In addition to meeting these criteria, University Health System has put into place a highly trained, multidisciplinary team consisting of the cardiologists, surgeons, cardiac anesthe- siologists and echocardiographers who make up the Heart Valve Clinic. When patients are referred with a diagnosis of aortic stenosis, providers at the specialized center complete a comprehensive evaluation to ensure patients are matched to the appropriate treatment. With a wide range of the latest treatment options available, the Heart Valve Clinic at UT Medicine's Medical Arts Research Center (MARC) offers a one-stop shop for its patients, many of whom travel great distances to receive the clinic's care. After initial consultation, patients undergo an electrocardiogram of the aortic valve to determine the severity of their disease and a computed tomography angiogram to measure the anatomical size of their affected valves. Additional tests assess the patients' level of frailty and comorbid risks, including pulmonary issues and stroke. A computed tomography scan provides information about the heart's rhythm. Patients are then seen by an interven- tional cardiologist and a cardiac surgeon. They also meet with a geriatrician and can see a neurologist when necessary, such as when a high risk for stroke exists. The resulting information from all the tests and physician consultations informs the Heart Valve Clinic's team in deciding whether or not the patient does have symptomatic aortic stenosis and, if so, whether his or her case would be best served by the TAVR technology or the standard open surgical procedure. According to interventional cardiologist Marvin H. Eng, M.D., the providers are careful to incorporate the new approach for only the most appropriate patients, including those for whom the traditional open procedure is considered too risky. Dr. Eng is part of the TAVR team at University Hospital and the Valve Clinic at UT Medicine. MDNEWS.COM ■ MD NEWS San Antonio | 7

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