Wheeling Hospital Among 40 Worldwide To Offer Heart Procedure

Wheeling Hospital is one of only 40 hospitals worldwide to replace aortic heart valves using the Transcaval approach for the transcatheter aortic-valve replacement procedure, the hospital reported in a statement released Thursday.

No other hospital in West Virginia or Pennsylvania offers the approach and it is available at only one facility in Ohio.

The TAVR team, led by interventional cardiologist Dr. Triston Smith and including interventional cardiologists Dr. Gregory Suero, Dr. Deepak Hooda and cardiothoracic surgeons Dr. Victor Maevsky and Dr. David Haybron, performs Transcaval TAVR at Wheeling Hospital.

“Only about 500 of these procedures have been performed worldwide,” said Wheeling Hospital CEO Ron Violi. “The ability to offer this amazing procedure in Wheeling demonstrates our commitment to care for patients close to home who otherwise would have to travel out of the area. Equally amazing is the cardiac team we’ve assembled — true medical pioneers.”

Nearly a year ago, Wheeling Hospital began performing TAVR to replace the aortic heart valve in patients with severe aortic stenosis who are at intermediate to high risk for open heart surgery.

With TAVR, a new valve is compressed and placed on the end of a tube-like device called a balloon catheter. It is inserted through the femoral artery in the leg and eased through the blood vessels until it reaches the diseased aortic valve. The valve is then expanded by the balloon and anchored to the diseased valve.

However, although the transfemoral route is the one most commonly used, some patients have severe blockages in the arteries of the legs making it impossible for the procedure to be done using that route. That is where the transcaval approach may be used.

“Transcaval TAVR involves taking advantage of the anatomic proximity of the vena cava to the aorta,” Smith said. “The inferior vena cava is a large vein carrying blood to the heart. In the abdomen it runs very close to the aorta, which carries blood away from the heart. We access the femoral vein in the groin and advance a catheter into the inferior vena cava.

“We then use an electrically charged wire to puncture a hole from the vena cava into the aorta and via a series of meticulous steps advance our equipment into the aorta,” he said. “We then proceed with replacing the aortic valve. The hole forming the communication between the vena cava and the aorta is plugged with an occlusion device when we are finished.”

Discussing the new procedure, Maevsky said, “When we introduced Transfemoral TAVR one year ago, it was a significant advancement in cardiac care, a wonderful procedure for certain patients with severe aortic stenosis. However, for others, Transfemoral TAVR is not an option so we went a step further to provide these patients with hope using Transcaval TAVR. We are among a small, yet elite, number of hospitals in the world providing this often life-extending option.”

In elderly patients, aortic stenosis is mostly caused by the calcium buildup on the aortic valve’s leaflets. Over time, the leaflets become stiff, reducing their ability to fully open and close. When that happens, a person’s heart must work harder to push blood through the aortic valve to the rest of the body. Eventually, the heart gets weaker, increasing the risk of heart failure.

“We are the region’s leader in providing area residents with the newest technological advancements,” said Violi. “With Transcaval TAVR, we have made the valve replacement an option for our patients who otherwise would have to travel far distances for such care. A special thanks to our structural heart team for accepting the challenge of learning and implementing this new technology, as well as the highly experienced support staff that works so closely with them.”

The TAVR and structural heart team are a part of a large team of specialists and support staff within the Wheeling Hospital Heart and Vascular Center.

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