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COVER FEATURE "The valves we are implanting are of the third generation, and the fourth and fifth generations are currently in clinical trials. These valves are just going patients in the community. Our goal is to help them get back to their homes, their regular providers and the activities that are important to them." to get better and better. There's no reason to be fearful of sending patients to get what can be a very life-changing procedure for them. We think it's important that this is a cooperative effort among the multiple specialties in our group and between our group and the physicians who care for these — A.J. Carpenter, M.D., Ph.D., cardiothoracic surgeon, Professor of Cardiothoracic Surgery at UT Medicine and Director of Cardiothoracic Surgery at University Health System At the Right Pace Typically, the team begins the TAVR procedure by accessing the femoral artery in the groin through a needle or a small incision in the artery. Specialists pass a dilator and a sheath into one side of the artery and insert a smaller sheath with a pacemaker into the other side. They then feed a wire through the artery to reach and cross the aortic valve. After confirming the measure- ments of the valve, the team performs a balloon valvuloplasty. The specialists then use the pacemaker Edward Sako, M.D., Ph.D. "This is an entirely new concept. Since the 1950s, the valves themselves have evolved to where there are many different kinds on the market, but until now, they have all been implanted by opening the chest, putting the patient on the heart-lung machine, opening the aorta, cleaning out the old valve and sewing in the new one," says Dr. Carpenter. "The concept behind this new procedure is delivering the implantable valve into position without the heart-lung machine or opening the chest. It's very innovative technology that expands the opportunity for treatment." 8 | San Antonio MD NEWS ■ MDNEWS.COM to pace the heart at a high rate to decrease the amount of blood being ejected for eight to 10 seconds while they inflate and deflate the balloon to open the narrowed valve. The heart is allowed to return to a normal pace as the team delivers the SAPIEN device, which consists of the valve mounted on a steel stent with a bal- loon inside. The device is passed through the widened valve and positioned in the correct location under X-ray guidance. The team employs the pacemaker a second time while inflating the balloon to secure the device. The process pushes the native valve into the heart's wall to implant the new valve. The balloon is deflated, and the heart is again returned to a normal pace. The team then assesses the procedure's results with an EKG, specifically evaluating valve placement and any possible leaks. Because the patients undergoing the procedure are typically of advanced age, they are transferred to the intensive care unit postoperatively for one night before being transferred to the recovery floor. According to Dr. Bailey, patients are discharged within two to five days and can sometimes return to normal activities in less than a week. Patients' follow-up care includes an evaluation at the Heart Valve Clinic within two weeks and at one month, six months and 12 months following the procedure. The schedule, however, can be adjusted to fit a patient's needs and foster collaboration with his or her primary care provider. "The TAVR procedure has been very beneficial in helping bring surgeons and cardiologists together. For a while, there was a great divide, but this procedure has been improving the collaboration," says Dr. Eng. "Many people are grateful for those opportunities. It makes interven- tional cardiologists more versatile, and the surgeons learn how to use wires and catheters. We've been able to teach each other many different things and have grown as a result of it." For refer ral s or more informa- tion, please call (210) 232-0362 or visit www.universityhealthsystem.com/TAVR. ■