Traverse City Record-Eagle

December 15, 2012

Procedure offers options for some patients


TRAVERSE CITY — Some area patients who may have been turned down for open heart surgery in the past are now getting relief through a new catheter-based technique.

Since September, Munson Medical Center's Structural Heart Clinic has been offering a new Transcatheter Aortic Valve Replacement procedure for some patients with aortic stenosis, an obstruction of the aortic valve. TAVR makes it possible to replace the valve without open heart surgery. The less invasive technique typically means a shorter hospital stay. Patients generally recover faster, too.

Nicklaus Slocum, M.D., a specialist in interventional cardiology who practices at Munson with Traverse Heart & Vascular, just came to Traverse City in July. As a fellow at the University of Michigan, he was involved in performing the procedure and was excited about getting in on the ground floor of Munson's program.

In TAVR, doctors basically replace the old valve with a new one.

"We don't take the old valve out," Slocum said. "We place a new valve "¦ usually a bioprosthetic valve either from a bovine or pig, on a metal cage. The old one just gets crushed to the side.

"This valve is being put in there, all through the groin — a tube through the leg just like a cardiac catheterization."

For older patients with more complex health issues, TAVR may mean the difference between getting their condition treated and not.

"Probably the sickest people with aortic stenosis should get this procedure," he said. "The younger, healthier folks without other medical comorbidities are still better off having open heart surgery."

And for those sicker people who qualify for TAVR, the procedure can mean a huge improvement in quality of life, said Janice Kelsey, coordinator of Munson's Structural Heart Program.

"Some of these patients, they didn't have really any alternative except to go to palliative care, so now this basically offers them another chance at life, or to have a better quality of life," Kelsey said. "I remember one of our patients, preoperatively could not walk from the wheelchair to the bed without assistance. After the procedure, they were walking down the hall, just full of color, pink cheeks and smiles.

"This is definitely changing lives."

TAVR was first performed in Europe in 2002. Today, Munson is one of just a few sites approved to perform the procedure, which Nicklaus said is also being offered in Petoskey and Grand Rapids.

"And at this point, it appears to be just as durable as far as years this valve will last as traditional surgery," Slocum said.

The other new aspect of TAVR for heart patients is the team approach it involves.

"One of the things you'll find with this procedure more than anything we do in cardiovascular medicine is, it's a whole different team than we're used to and a much broader team," Slocum said. "It's a combination of a cardiologist, folks like me echocardiographers — those are cardiologists who are trained to read radiology pictures of the heart — combined with cardiac surgeons," he said. "So there's not really one person taking care of the patient, but really a group of people because these patients have become so complex.

"The folks in oncology have been doing this for years. They've had this idea of multiple modalities sitting down and seeing patient cases as a group. We're a bit behind, but it's a lot of fun catching up."

From Slocum's view — and the patients who have undergone the procedure so far, TAVR opens doors that were once closed.

"The most important thing about this procedure is we're able to help people who previously had no options," he said.