The Record Special Sections Health Quarterly 02-16-2020 | Page 14

14 ❚ SUNDAY, FEBRUARY 16, 2020 ❚ THE RECORD
HEALTH QUARTERLY / ADVERTISING SECTION
Minimally Invasive
TAVR Is ‘Paradigm Shift’
In Heart Valve Repair
T
he days of open-heart surgery
are medical history. Dr. Arash
Salemi, clinical chair of cardiotho-
racic surgery at RWJBarnabas
Health, calls a new procedure to replace
failing aortic valves nothing less than “a
game changer.”
The procedure, transcatheter aortic
valve replacement (TAVR), offers a
minimally invasive option for surgeons
to replace an old, narrowing valve, giving
ever-more patients many more years of
good heart health.
Here, Dr. Salemi dives
deeper into TAVR and its
benefits for patients, which
include no incisions, a shorter
recovery period and, most
importantly, fantastic long-term results.
Q: What is TAVR? Is this considered
among the more minimally invasive
heart procedures?
A: Transcatheter aortic valve replace-
ment is aortic valve replacement without
the need for an incision, without needing
a heart-lung machine and without having to
stop the heart. It is a suture-less technique.
TAVR is minimally invasive, both physio-
logically and anatomically.
Physiologically, the standard of care
for 50 years has been open-heart surgery,
stopping the heart, during which time you
replace the valve while organ function is
sustained by the heart-lung machine. TAVR
is less invasive physiologically because
the heart maintains its pumping function
throughout the procedure. It is anatomically
less invasive because, typically, there
are no incisions and you don’t need to
enter the breast bone as you would with a
surgical approach.
Q: What makes TAVR a better
procedure than other valve replacement
operations?
A: In terms of intermediate-term out-
comes, TAVR and surgical replacement are
similar. But TAVR, because of its minimally
invasive nature, provides a much quicker
recovery period. Patients generally are in
the hospital for a day or two after the pro-
cedure. With open-heart surgery, while the
longer-term results are similar, the recovery
phase can last as long as six weeks.
Q: How has it changed the way surgery
is performed?
A: It has changed the way we evaluate
patients with aortic stenosis. It is very com-
mon for patients over age 65 to have some
degree of narrowing. When the narrowing
becomes severe, treatment is warranted
and necessary. We have achieved great
results with open-heart surgery, but over
the past decade, TAVR has allowed us to
provide care to a broader base of patients
with a quicker recovery time.
Q: Who is a candidate for TAVR,
and who is not?
A: TAVR was first invented for patients
at too high risk
for standard
valve replace-
ment. Until TAVR,
surgery was only
for those patients who we thought could
tolerate the operation.
That means a large cohort of patients
were left without treatment of a progres-
sive heart condition. There are no medical
therapies for aortic stenosis — no diet, no
exercise regimen, no medication that can
treat it. As the technology developed, we
began to conduct clinical trials on patients
who were healthier. These have demon-
strated that patients ranging from low to
high risk with open heart surgery all benefit
from TAVR. Everyone with a narrowing
A
Patients Experience Quicker Recovery
Doctors Arash Salemi, front left, and Sabino Torre, rear left, with members of the
RWJ Barnabas Health TAVR (Transcatheter aortic valve replacement) Team.
of the aortic valve is now a candidate
for TAVR and should warrant an evaluation.
Q: What happens during the TAVR
procedure?
A: The TAVR procedure generally
takes about one hour. Patients are typically
sedated, with general anesthesia used
in only about 15 percent of patients. It is
typically performed through the arterial
blood stream — 95 percent of cases are
performed through the femoral artery in
the leg. A catheter with the new aortic
valve is passed through the blood stream
and X-ray guidance is used to position it
inside the patient’s diseased native valve.
Then the new valve is expanded into that
space. The old valve is pushed aside against
the aortic walls, giving the patient a brand-
new valve to allow adequate blood flow.
Dr. Arash Salemi
rash Salemi, MD, a board-
certified cardiothoracic surgeon,
is the clinical chairman of car-
diothoracic surgery for RWJBarnabas
Health in the northern region. He pro-
vides strategic direction for the health-
care system and clinical oversight for
the cardiothoracic surgery programs at
Newark Beth Israel Medical Center, Saint
Barnabas Medical Center and Jersey
City Medical Center.
Dr. Salemi received surgical training
at the New York Presbyterian Hospital-
Cornell, Memorial Sloan Kettering
Cancer Center and the Cleveland Clinic,
where he specialized in valve repair.
He also completed post-graduate spe-
cialty training in endovascular surgery
and interventional cardiology at the
University
of Paris and
San Raffaele
University in
Milan. He per-
forms all forms
of adult cardiac
surgery, with a
particular inter-
est in valvular
heart disease.
An international leader in structural
heart disease, Dr. Salemi has performed
more than 2,000 transcatheter aortic
valve replacement (TAVR) proce-
dures. Dr. Salemi sees patients at all
three hospitals and will perform surgery
at both Newark Beth Israel and Saint
Barnabas Medical Centers.
Q: What is the recovery like?
A: The patient recovers in the Intensive
Care Unit overnight where we monitor
blood pressure and heart rhythm.
About one-third of our patients go home
the following day, another third the day
after that and the rest shortly thereafter.
The average length of stay is a day and a
half. There may be some soreness at the
puncture site in the leg, but it is minimal.
Patients typically take a baby aspirin as a
blood-thinning agent every day thereafter,
and we may add additional antiplatelet
agents for up to six months, depending
on the case. Patients are advised to take
a couple of weeks off to get back on their
feet and follow up with their doctors. There
are no long-term restrictions.
Q: How is the TAVR program at
Saint Barnabas Medical Center (SBMC)
expanding, and why?
A: Because of the great outcomes
and quick recovery, our TAVR program
is expanding rapidly. We are streamlining
our patient workflow and are expanding
our team of surgeons, support staff and
operating room locations, so we can see
patients three to five days a week and per-
form procedures expeditiously. We are also
actively involved in numerous clinical trials
in this space, so that we may offer the most
current therapies to our patients.
Q: What else should the public know
about TAVR and SBMC’s program?
A: We are committed to patient care.
Our goal is to provide the highest quality
care to the broadest population of patients.
TAVR is a transformative technology. It has
been a paradigm shift in the care of aortic
stenosis and we are proud to offer it.
To make an appointment with Dr. Salemi
at Saint Barnabas Medical Center, call 973-
926-6938.