Vaneohs structural heart team performs milestone 100th tavr procedure | va northeast ohio health care | veterans affairs

In 2017 medical professionals from the Louis Stokes Cleveland VA Medical Center developed a Structural Heart program. By 2019 construction on two state-of-the art hybrid operating rooms was

completed. This allowed a space where advanced open operations, along with interventional or catheter-based procedures, and operations can be performed. In May of 2019 the first

Transcatheter Aortic Valve Replacement (TAVR) was performed. On July 27, 2022, the team completed a milestone 100th TAVR procedure. THE 100TH PATIENT 77-year-old U.S. Air Force Veteran,

Perry Fennell, was seen for feelings of increased fatigue and shortness of breath. His Primary Care doctor discovered a murmur during his heart exam and an echocardiogram detected severe

Aortic Stenosis (AS), a degenerative narrowing of a heart valve. Mr. Fennell underwent further medical testing and was referred to the Structural Heart Team in June. Mr. Fennell had a

history of other severe medical problems which were well managed but also put him at increased risk for complications from an open-heart surgery. Mr. Fennell also has a difficult time

walking and both he and his loved ones were very concerned about how he would manage after a major operation. Once the Structural Heart Team completed and reviewed all the testing, it was

decided that he would be a candidate for TAVR. THE PROCEDURE The Transcatheter Aortic Valve Replacement, or TAVR, is a procedure that delivers a replacement valve through a large leg or

chest wall artery rather than open heart surgery approach. Historically, this would be done through an open-heart surgery. Unfortunately, some patients, especially those with Aortic

Stenosis, also have other severe medical problems making open heart surgery far more dangerous. In the mid-2000s, TAVR was first introduced for patients who were inoperable. Later clinical

trials demonstrated that the TAVR procedure was safe for patients who were considered high or moderate risk for complications with open heart surgery. Finally, in the late summer of 2019,

TAVR was considered for those who would have a low risk of complications from an operation to replace the valve. Prior to 2019, patients with AS would be evaluated to determine their risk

factor. If they were inoperable or high-risk for surgery, a community care hospital would perform the actual TAVR. The VANEOHS Structural Team would do the entire work up and later follow up

but not perform the procedure. Since beginning to perform TAVRs in May 2019, our talented team as performed 100 procedures with excellent results and lower than average complication rates.

Before the procedure can be performed, patients go through an extensive work up process which typically needs to happen quickly. The patients are generally older and have may have other

medical challenges. The Structural Heart Team meets with the patient to discuss the available treatment options and then review the testing to come up with the best plan for the patient. In

certain cases, surgery or TAVR may not be an option as some patients are at the end of their life. Once a plan has been made the patient will be admitted and prepped for the procedure.

Typically, patients will receive sedation and local anesthesia. The procedure lasts about 90 minutes, with more than two thirds of patients going home the very next day with no incisions or

special care. More than 90% go home by post op day 2. Surgery patients usually stay 5-7 days and high-risk patients can stay much longer. THE OUTCOME The procedure went exceptionally well.

After a brief period of observation, Mr. Fennell was able to go home the very next day. Later in the week, he was on the mend, and on his riding lawnmower, taking care of his yard and

getting back to normal. THE TEAM The positive outcome of Mr. Fennell’s procedure wouldn’t have been possible without the dedication and skill of our incredible Structural Heart Team: Yakov

Elgudin, MD PhD-chief, Cardiac Surgery, Noah Rosenthal, MD- Cardiologist and Director of the Cardiac CathLab, Mohammed Najeeb Osman, MD, Cardiologist and Electrophysiologist, Jonathan

Goldberg, MD, Cardiologist, and Deborah Catania, RN APRN, Structural Heart Coordinator. The TAVR procedure is the result of collaboration not only from the physicians but also their larger

teams: cardiac surgery, cardiac cath and EP lab, and OR. Many other departments to include anesthesia, echocardiography, radiology, vascular surgery all came together to perform this amazing

procedure for our Veterans right here, at the Louis Stokes Cleveland VA Medical Center.