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TAVR: ‘A major change in health care’

MARQUETTE — You can hear the enthusiasm in the voice of Dr. David Pesola, Interventional Cardiologist, when he talks about Transcatheter Aortic Valve Replacement — TAVR — a procedure offered at UP Health System-Marquette.

“This (procedure) is a major change in health care,” Dr. Pesola said. “It reduces the number of patients who have to have their chest opened for a valve replacement. It allows people to live longer, especially older people, as they can have their aortic valve done through the leg. For many of these older people, they would not be able to have the other kind of surgery.

“And it’s easier on the patient,” he said.

Easier as in the patient will only spend two or three days in the hospital after a TAVR procedure compared to the five to seven days hospitalization, on average, for someone who had to have his or her chest opened for the valve replacement.

“Then there will be about six weeks of healing for that patient, then another six weeks to get strength back,” Dr. Pesola said. “That’s a lot to go through.”

A TAVR patient will be back to a regular schedule much more quickly.

“There are many advantages,” he said. “The valve will function beautifully after it’s replaced. And the recovery will be faster as there are just little incisions in the groin that need to heal as opposed to having an open chest (suture) to heal.”

UPHS-Marquette has been offering the procedure for about three years, Pesola said. He and Dr. Kris Dosh are a team that does the TAVR, with Dr. Bradford Blakeman the heart surgeon involved in the procedure.

In the traditional valve replacement surgery, the patient would have his/her chest opened and be put on a heart-lung machine, Dr. Pesola explained. “The worn (aortic) valve is replaced by suturing the new valve in, then the patient’s heart is put back to beating again.”

The Transcatheter Aortic Valve Replacement uses an artery in the leg, which is large enough to accomodate a small tube.

“The replacement valve is put into a small tube. It’s made in a certain way … it’s spring-loaded and goes back into the same shape once the tube is sent through the leg through an opening in the groin. It takes about 10 seconds to replace the valve as the new valve goes into place.”

Elderly patients at a high risk could not have the open chest procedure at all. The TAVR procedure gives many of them years of life they might not have had otherwise.

“The results are quite good. Now we can offer TAVR to medium-risk patients,” Dr. Pesola said. “Research shows we can replace the valves with success.”

Patients under age 60 to 65 at low risk may not be eligible for the procedure yet. And there are three additional heart valves which cannot be replaced in this way.

Not yet, at least.

“The research is ongoing on the other three valves. That’s where the research is going next,” Dr. Pesola stated. “It’s exciting to be involved in this. It’s a huge change in heart disease care.”

While the Transcatheter Aortic Valve Replacement procedure is relatively new, there’s more good news.

“If needed, we can put another aortic valve replacement in. It can be redone,” he said. “We think the first valve will last about 15 years, then can be done a second time. That’s the beauty of this valve procedure.”

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