Cardiologists, Cardiac Surgeons Perform First Trans-catheter Aortic Valve Replacement at LLUMC

A joint team of cardiologists, cardiac and vascular surgeons and cardiac anesthesiologists completed the first trans-catheter aortic valve replacement (TAVR) at Loma Linda University Medical Center (LLUMC) on Oct. 28, and the patient is doing well. LLUMC is the first hospital in the Inland Empire to perform this type of procedure. This new therapy is used to treat certain patients who are symptomatic with severe aortic valve stenosis, shortness of breath, chest pain, heart failure, light-headedness, and syncope. TAVR provides an alternative to open heart surgery for patients who are considered inoperable. The team consisted of cardiologists Anthony Hilliard, MD, and Kenneth Jutzy, MD; cardiothoracic surgeons Anees Razzouk, MD, and Rosario Floridia, MD; vascular surgeon Ahmed Abou-Zamzam, MD; Jason Gatling, MD, and Ryan Lauer, MD; and anesthesia and echocardiographers Ramesh Bansal, MD, and Ramdas Pai, MD. "This procedure requires the collaboration of cardiologists and cardiac surgeons to evaluate and select patients in order to provide the best outcomes," said Dr. Razzouk, Chief of Cardiothoracic Surgery at LLUMC. "Loma Linda University Medical Center was selected as the site to do this procedure, partially because our traditional approach to patient care has been a team approach, especially when it comes to cardiac patients. We work daily with cardiologists and other professionals to present the best options of care for our patients." Typically, aortic valve replacement (AVR) can be lifesaving for patients with symptomatic aortic stenosis. However, the process would normally involve opening the chest, stopping the heart and placing the patient on a cardiopulmonary bypass machine. Because of the invasive nature of this approach, about 30% of patients with severe aortic stenosis who also have concomitant comorbidities are not considered surgical AVR candidates and would likely not survive beyond two years after symptom onset. “With TAVR, patients can receive the treatment they need and experience a better quality of life,” said Dr. Jutzy, head of the Department of Cardiology. TAVR is a nonsurgical approach that yields survival benefits equivalent to conventional AVR surgery but with shorter procedure times and reduced anesthesia requirements. The procedure involves replacing a narrowed aortic valve using less invasive catheter-based techniques, and the new valve is attached to a catheter inserted into the aorta. The procedure time for TAVR is generally two to three hours. The TAVR program at Loma Linda University International Heart Institute includes a comprehensive team approach to assessment and treatment involving all participating departments. The team includes an intake coordinator, interventional cardiologists, cardiothoracic surgeons, cardiac anesthesiologists, echocardiographers, radiology professionals, vascular surgeons, nurses and technologists specially trained in TAVR protocols.