UAB adds unique life-saving treatment to heart-valve program

New minimally invasive procedure to replace damaged aortic valves can help patients for whom open surgery is not an option.

The University of Alabama at Birmingham Hospital is the first facility in Alabama to offer a new minimally invasive procedure for replacing heart valves in people with aortic stenosis who are not candidates for an open procedure.

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UAB interventional cardiologists Massoud Leesar, M.D., (far left) and Mark Sasse, M.D., (center) and cardiothoracic surgeon James Davies, M.D., (far right), along with UAB TAVR team members and representatives from Edwards Lifesciences, go over a mock procedure to prepare for UAB’s first TAVR case in early August.

Physicians in UAB Heart and Vascular Services, home to the state’s largest and oldest heart valve disease treatment program, are the only ones in Alabama trained to offer the Edwards Lifesciences SAPIEN transcatheter heart-valve-replacement system — the only transcatheter valve replacement therapy approved for commercial use in the United States.

UAB cardiothoracic surgeon James E. Davies, Jr., M.D., assistant professor in the UAB Division of Cardiothoracic Surgery, says the team is on schedule to perform its first surgery in early August.

“Given the fact that we perform more valve procedures overall than anyone in the state — and have since the inception of our program – we are excited to be home to Alabama’s most comprehensive valve clinical and surgical treatment program and to be the first to offer this unique, life-saving procedure to the people of Alabama and surrounding states,” Davies says.

UAB Heart and Vascular Services is home to the state’s largest and oldest heart valve disease treatment program.

According to the American Heart Association, nearly 1.5 million people in the United States suffer from severe hardening or narrowing of their aortic valve — known as aortic stenosis — and approximately 500,000 suffer from a severe form of the disease. It is estimated that 250,000 of these patients suffer from symptoms, which include severe shortness of breath, extreme fatigue, chest pain and fainting.

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Echocardiologist Julian Booker, M.D., performs an echocardiogram on a patient in preparation for the state’s first catheter-based aortic valve replacement using Edwards Lifesciences SAPIEN transcatheter heart-valve-replacement system as interventional cardiologist Massoud Leesar, M.D., looks on.

In elderly patients, severe, symptomatic aortic stenosis is often caused by the build-up of calcium on the flaps of tissue that open and close the aortic valve, impairing its ability to regulate the flow of blood through the aortic valve. As a result, the narrowed valve allows less oxygen-rich blood to flow from the lungs to the brain and the rest of the body.

Davies says current American College of Cardiology/American Heart Association guidelines recommend treating virtually all patients with severe, symptomatic aortic stenosis with surgical aortic valve replacement and that open-heart aortic valve-replacement surgery is the gold standard. However, there are patients who are not candidates for open surgery – basically open heart surgery requiring bypass – because of age, history of heart disease, frailty or other health issues. But, without replacement of the aortic valve, the disease is life-threatening.

“Patients who have severe aortic stenosis have a 50 percent chance of dying within one-and-a-half to two years after the onset of symptoms without treatment,” Davies says.

Edwards SAPIEN transcatheter heart-valve replacement was approved by the U.S. Food and Drug Administration in November 2011. It has been designed specifically for patients suffering from severe, symptomatic aortic valve stenosis for whom open-heart aortic valve-replacement surgery is too risky. Instead, the balloon-expandable SAPIEN valve is inserted via a catheter through a small cut in the thigh into the femoral artery. The physician then threads the catheter up to the heart and puts the valve into place. In all, the procedure takes from two to four hours. The average hospital stay is two to four days, and recovery time is one to two weeks.

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Cardiothoracic surgeon Spencer Melby, M.D., interventional cardiologist Seun Alli, M.D., interventional cardiologist Massoud Leesar, M.D., and cardiothoracic surgeon James Davies, M.D., are part of the interdisciplinary surgical team that performed Alabama’s catheter-based aortic valve replacement using Edwards Lifesciences SAPIEN transcatheter heart-valve-replacement system Aug. 6, 2012 on and 89-year-old man.

“Approximately 30 percent of patients with aortic stenosis are unable to have the traditional surgery, and until recently the prognosis for those patients was poor,” says Massoud A. Leesar, M.D., professor and section chief of UAB Interventional Cardiology. “For these patients, this procedure adds years to their lives and life to their years. Patients who undergo this therapy experience a much higher quality of life.”

UAB’s TAVR program got off the ground in May 2012 when Heart and Vascular Services expanded its valve clinic offerings to treat patients with end-stage aortic valve disease. In this clinic, patients undergo a comprehensive evaluation by a multi-disciplinary team of specialists, including cardiologists and cardiac surgeons, to determine whether TAVR is an appropriate option. In some cases, Leesar cautions, it may not be an option because co-existing medical conditions would prevent the patient from experiencing the expected benefits or because the risks outweigh the benefits. Also, many patients referred for the TAVR procedure may be deemed a candidate for standard aortic valve replacement.

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Interventional cardiologist Seun Alli, M.D. (left), cardiothoracic surgeon Spencer Melby, M.D. (center), and interventional cardiologist Mark Sasse, M.D. (right), are part of the UAB team performing catheter-based aortic valve replacements.

The initial TAVR patient evaluation and treatment team includes:

  • James E. Davies, Jr., M.D., cardiothoracic surgeon
  • Spencer Melby, M.D., cardiothoracic surgeon
  • Massoud Leesar, M.D., interventional cardiologist
  • Mark Sasse, M.D., interventional cardiologist
  • Seun Alli, M.D., interventional cardiologist
  • Julian Booker, M.D., echocardiologist
  • Satinder P. Singh, M.D., radiologist

In addition to offering TAVR, the UAB Comprehensive Valve Program — which includes a multidisciplinary team of interventional cardiologists, cardiac surgeons and expert staff — provides aortic and mitral valve treatment, offering interventional and surgical treatment options including valvuloplasty, valve-replacement surgery, robotic valve repair, valve-sparing aortic root replacement and the Ross Procedure. In addition, the program is the most equipped and experienced facility in the state for treating and managing adults with congenital valve disease, Davies says.


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