Non-invasive heart valve surgery now offered at Mercy

One in every four deaths each year are from heart disease and every 40 seconds someone in the U.S. has a heart attack. For those too sick to undergo traditional heart surgery the risk of dying from heart disease is high. The death rate is about one person every minute, according to the Centers for Disease Control.

Doctors at Mercy Hospital in Northwest Arkansas now have an answer for ill heart patients needing valve replacement without the risks of open heart surgery. The procedure is known as transcatheter aortic valve replacement, sometimes referred to by the acronym TAVR. During the procedure, a team of cardiologists and cardiothoracic surgeons go through an artery in the thigh to reach and replace a patient’s diseased heart valve.

Similar to the placement of a coronary stent, the minimally invasive treatment takes place while the patient is under minor sedation. A balloon catheter equipped with a replacement valve is inserted into the Transfemoral artery where it is guided to the heart, the balloon catheter inflates to expand the replacement valve into the aortic valve’s space. A pacemaker is also used in the procedure to slow down the heart’s beat while the the valve is being replaced. The entire procedure takes about an hour and a patients’ hospital stay is limited to a few days.

“There were patients who once were doomed to be inoperable and there was no other hope for them. It was almost equal to terminal cancer,” said Dr. Amr El-Shafei, an interventional cardiologist with Mercy. “This procedure allows those patients to survive and thrive. They will see an improvement in their quality of life right away.”

85-year-old Springdale resident Mary Anne Erlinger was the first to have the TAVR procedure done in the region when the team of doctors performed their first five operations on Valentine’s Day. She was experiencing shortness of breath which worsened between doctor visits. After several electrocardiograms a compressed heart value was detected by El Shafei.

Given her age, he said Erlinger was a high risk for the traditional heart valve replacement surgery which made her a good candidate for TAVR. She said the discomfort was minimal with recovery and she went home on the third day following surgery. Erlinger recently told Talk Business & Politics there was a little bruising on one of her legs but that was the only issue since surgery.

“I could hardly breath before I had it done and today I feel just fine,” Erlinger said. “Dr. Parmley explained it to me and I remember the anesthesiologist talking to me before surgery but that’s the last thing I remember. I woke up breathing fine.”

Erlinger said she is eager to begin a short round of rehabilitation following her surgery and feels like she has a new lease on life.

Dr. Matthew Parmley was the cardiothoracic surgeon who performed the procedure with El-Shafei. The doctors said her prospects were bleak without fixing the valve because the heart was having to work hard to pump blood through compressed valve.

“Typically when the valve is that closed a patient might only have a few months to live,” El-Shafei said. “The only alternative would be to do a high-risk traditional surgery that takes about 4 to 5 hours and requires the patient be placed on a bypass machine with considerably more downtime for recovery.”

Erlinger said when the risks were explained, she opted for the quicker non-invasive procedure, even through the cost is as much or more than the traditional surgery. Parmley said the cost of the valves is the major expense of the TAVR procedure. He said there are only two manufacturers in the U.S. for the valves, but once the procedure becomes more common the cost should go down. For instance in Germany, where El-Shafei studied the technique, the cost is considerably lower because there are more manufacturers.The doctors said the lifespan of the valve is about seven years because so many of those getting the procedure have been 80 years or older and die from other reasons. The doctors said as more patients get the procedure it is believed the valve will last longer than 7 years.

Parmley came to Mercy Health about six years ago from St. Francis Hospital in Tulsa where the procedure was already being performed. He said larger metro hospitals have been doing the procedure for several years on mostly older patients who are a high risk for traditional surgery. But with recent FDA approval for TAVR use in moderate-risk patients that paved the way for hospitals like Mercy to invest in a hybrid dual lab operating room and begin providing the TAVR procedure here at home.

El-Shafei said the hospital has referred patients out for this procedure. Based on the demand he expects the hospital will do about 40 cases a year. He said that would be typical for a U.S. hospital, but far less than the 800 or so in Germany each year.

Dr. Lance Weathers, like El Shafei, is an interventional cardiologist and Dr. Anton Cherney is a cardiothoracic surgeon with Parmley. The doctors work in pairs with a cardiologist and a surgeon each performing parts of the procedure. The two teams have completed five TAVR procedures – as of March 1 – and expect to do about two or three a month.

“Our collaboration continues throughout, from the initial evaluation of the patient, through the procedure, all the way up to when we follow up with the patients and they are safe at home,” El-Shafei said.

Although the TAVR procedure is new to Northwest Arkansas, all of the TAVR team physicians have prior experience performing TAVR.

“This is a procedure that’s been very well studied and very well proven to benefit patients,” said Cherney, who was trained at Beth Israel Hospital in Boston. “It hasn’t been around for nearly as long as open-heart surgery but there have been multiple trials showing its tremendous benefit to patients. There’s plenty of data to support this procedure.”

Weathers spent time at Baylor Hospital in Dallas learning the procedure and said Baylor has been on the ground floor of trials for TAVR for several years.

When asked why the TAVR procedure is not approved for everyone, Dr. El Shafei said it comes down to mortality risks and the overall risks for the traditional valve replacement surgery is low given that it’s been done for so long in this country. He said as more TAVR procedures are done the mortality risks will likely change. It will be up to the FDA as to when the procedure can be offered to anyone needing valve replacement.

“I’m excited because it opens up a whole new group of patients who we can treat more quickly and with a much shorter recovery period. There’s no need to leave Northwest Arkansas for your heart and vascular care. We can take care of you right here,” Parmley said.

Mercy officials said no other hospital in the region offers the procedure.