New procedure helps those too ill for open heart surgery

CEDAR RAPIDS - A new heart procedure now offered at UnityPoint Health-St. Luke's Hospital will help elderly patients too high-risk for open heart surgery.

The transcatheter aortic valve replacement, or TAVR, is a less invasive option for patients that are too high-risk or sick for surgery, said Dr. Wassef Karrowni, an intervention cardiologist at St. Luke's.

Aortic stenosis - which affects 3 percent of people 65 and older - is a common heart problem caused by a narrowing of the heart's aortic valve. Karrowni said calcifications or fat can develop on the valve, causing it to narrow and making it harder for blood to move throughout the body.

This can cause heart failure, chest pains and increased risk for sudden cardiac death.

The surgical procedure repairs the damaged valve by inserting a replacement valve into the aortic valve. Similar to a stent placed in an artery, TAVR delivers a fully collapsible replacement valve to the valve site through a catheter.

'In the past 10 years, there has been a rapid progression in minimally invasive catheter procedures,” he said.

The hospital already has identified patients who are good candidates for the procedure, Karrowni said. These are high-risk patients who typically are 80 years old and older, he added. The hospital anticipates performing 30 cases at St. Luke's the first year and 55 to 60 cases the second year.

St. Luke's likely will begin offering TAVR in early fall after upgrades are made to the procedure room. St. Luke's Foundation has contributed $225,000 to accommodate TAVR cases in the Nassif Heart Center at the hospital.

The U.S. Food and Drug Administration is now studying low-risk patients for the surgical procedure, Karrowni said, adding it could soon become more commonplace.

'In four to five years, this could be the way we treat (aortic) valve patients,” he said.

The number of open heart surgeries in Iowa and across the country have begun to decline in the past decade as medications, cardiac catheters and stents have become more widely used, according to Society for Thoracic Surgery.

Karrowni said the procedure, covered by most insurers, can be more pricey than traditional open heart surgery because the collapsible replacement valve used is expensive. However, medical-device manufacturers are working to get the price of the valves down, he said, and because the procedure isn't as invasive as open heart surgery, that means a shorter hospital stay and fewer complications.

UnityPoint Clinic Cardiology and Physicians' Clinic of Iowa physicians will be the first in Cedar Rapids to offer the procedure, Karrowni said. It also is offered at University of Iowa Hospitals and Clinics and Mercy Medical Center in Des Moines.

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