Less Invasive Open Heart Surgery (TAVR) Now Available

July 13, 2021

Less invasive open heart surgery called TAVR now available and being performed on eligible patients at MercyOne North Iowa Heart Center

MercyOne North Iowa Cardiology Specialty at Mason City Clinic is now offering a new minimally invasive heart procedure called Transcatheter Aortic Valve Replacement or TAVR for people who have aortic valve stenosis, a condition when the heart’s aortic valve thickens and calcifies preventing the valve from opening fully and limiting blood flow from the heart to the rest of the body.

On this podcast, Farez Siddiqui, MD, Interventional Cardiologist describes the surgery, who is a candidate for it and what are the outcomes for patients who have had it. Said Dr. Siddiqui who was part of the team instrumental in getting this procedure to Mason City, “This procedure is a big city procedure and we are now offering it in Mason City. Having a heart procedure is a stressful time for a patient and their families, and in the past they would have to travel hundreds of miles to get TAVR. Now it is available to North Iowans close to home.”

To schedule a consultation, call: 641-494-5300

Transcript of Podcast

Carol Gifford (host):

Welcome to Mason City Docs on Call, a podcast series with MercyOne North Iowa specialists who educate us about how to stay healthy. I’m your host, Carol Gifford.

Transcatheter aortic valve replacement, or TAVR for short, is a minimally invasive heart procedure for people who are at a moderate to high risk of complications from open-heart surgery. With us today to discuss TAVR and who may be a good candidate for this procedure is interventional cardiologist at MercyOne North Iowa cardiology specialty, Dr. Farez Siddiqui. So Welcome to the program, Dr. Siddiqui.

Farez Siddiqui, MD  (Interventional Cardiologist):

Thank you so much.

Carol Gifford (host):

Before we get into talking about the TAVR procedure, help us understand this health condition for people that if they have aortic valve stenosis. What is this condition and how does it affect someone’s quality of life?

Farez Siddiqui, MD  (Interventional Cardiologist):

Absolutely, and I thank you for this opportunity. So everyone has four valves, and the aortic valve is one of the four valves. It’s one of the main valves. It’s kind of a connection between left ventricle that is a cavity that pumps blood out of the heart to the rest of the body. And over time it’s, with wear and tear, starts to degenerate. There’s a lot of calcium buildup, so it doesn’t open properly. And we’re seeing it more and more as better medicine, modern medicine, people are living longer, we are seeing more wear and tear. We’re seeing more prevalence and incidents of this condition. So that whole process where it starts to open becomes tight, doesn’t open that well. That whole process and condition is known as aortic stenosis.

Carol Gifford (host):

And so if untreated, what happens?

Farez Siddiqui, MD  (Interventional Cardiologist):

So these patients, they start to have a lot of symptoms which may be shortness of breath, which may be chest pain. They cannot even do a few steps before getting short of breath. They might feel dizzy, lightheaded, they might pass out. So yes, it’s a very dangerous and could be a fatal condition if left untreated.

Carol Gifford (host):

Tell me the difference between a TAVR procedure and a standard heart valve replacement surgery, because it sounds like patients who are not eligible for the typical valve replacement, this is an option for them.

Farez Siddiqui, MD  (Interventional Cardiologist):

Correct. So traditionally for many decades, the only option was an open-heart surgery where you cut open a chest and replace the valve. But over the past decade, mostly a decade, it’s even before that, but mostly more the past decade, this is a second option. And now it’s actually more popular than the first option. Where we do it minimally invasive to a small hole at the top of the leg, just like a regular stent procedure. So it is a lot different, it’s less time, less recovery, and they can go back to their routine life in a matter of days.

Carol Gifford (host):

So are you doing it because it’s less invasive, or is there something that a patient is unable to be a candidate for the typical valve replacement? What is the reason? It sounds like it’s because it’s minimally invasive, but is there another reason people would have this versus a typical valve replacement?

Farez Siddiqui, MD  (Interventional Cardiologist):

It actually is the other around. The patient needs to be really a bad candidate for this procedure to be now eligible for open heart surgery, because this is now almost like a first line, first option. And if they’re not good candidate for this type of minimally invasive procedure, then we give them an open-heart surgical option. So yes, for this reason, less risk of complications, less recovery time, and yeah, so mostly for those reasons. Yes.

Carol Gifford (host):

So it’s minimally invasive. So tell me how long the procedure is, and how long the recovery is, and how quickly people get to feeling better.

Farez Siddiqui, MD  (Interventional Cardiologist):

So it’s very similar to when our patients get a stent. They come in same day, early in the morning. They don’t need to get admitted before the procedure, so they come in same day. There are a lot of preparations that go into place. When they are ready, they are taken to our cardiac catheterization lab where they are sometimes and mostly put under general anesthesia. There might be some cases when we are able to do just with moderate sedation. And after that, we just make a small incision right at the top of the leg near the groin region, almost five to six millimeters in size. And we go with the wires and catheters. We take this valve over the catheter, inside the heart, and we inflate the valve and it kind of deploys inside the old valve, patient’s own valve.

And we have our echo sonographers, the ultrasound technicians with us. We have our echo specialists with us in the room. We take two pictures. If you’re happy with the procedure, the results, that’s it. We get out, we close that small incision with a stitch, and we take the breathing tube out. And patients are up and awake even before they leave our lab.

Carol Gifford (host):

And so they’re in and out in a day, or do they stay one night overnight?

Farez Siddiqui, MD  (Interventional Cardiologist):

So they do. At least for now we are observing them in our ICU for a day. But by the end of the day, they’re up and about, they’re walking, they’re sitting up in the bed eating, there’s no restrictions. And the next day mostly there, they can go home.

Carol Gifford (host):

So this aortic valve stenosis is a very serious health condition. And so they have this kind of procedure where they’re not… You’re not replacing the valve, you’re just putting this new kind of valve in. And so what’s the prognosis for a patient? Does this last for what, 5 years, 10 years longe? Sounds like it’s such a wonderful minimally invasive procedure. How do patients do with it?

Farez Siddiqui, MD  (Interventional Cardiologist):

Right. So that is actually an excellent question. That is something we decide between myself and the surgeons, which option is good for them, because surgical option is a very old option. That’s been there for 50, 60 years. So we know the [inaudible 00:07:10] that valve lasts around 10 to 12 years. Maybe less, maybe more. Now this valve is still relatively new, and we have good data for six to seven years. And it works absolutely fine for six, seven years. So we don’t know what’s the longterm longevity of this type of valve, but so far the data we have, it works very well during that period of time. But as time progresses, we will have more data. So we will have more information exactly how long these valves usually last. But we know for sure that at least six, seven years it lasts very good.

Carol Gifford (host):

Which is a long time now. What would be the option at six or seven years if it wasn’t operating as well? Then what happens?

Farez Siddiqui, MD  (Interventional Cardiologist):

Again, a great question. And patients always ask this. So this is a… They still have options. And there are ways that, especially with this TAVR, that we are able to deploy another valve inside the previously deployed valve with absolutely almost similar results to like a patient will have only one valve in. So yes, there are still options.

Carol Gifford (host):

We were talking earlier, so this is a new procedure within the last year that you’ve gotten this capability here at MercyOne. And so are we as MercyOne the only medical facility in Northern Iowa that’s offering it?

Farez Siddiqui, MD  (Interventional Cardiologist):

Yes. So historically our patients had to travel hundreds of miles, north and south to get this type of treatment and care. But now they can get it here, right here in Mason City, the only facility offering this care in the Northern Iowa. And this type of procedure is a stressful time. And so now they can get this done amongst their family, friends, and loved ones. So it helps them a lot. And this was kind of a need for a while now. And I’m glad that we were able to offer this here.

Carol Gifford (host):

Yes, it’s nice to have a procedure like this close to home.

Farez Siddiqui, MD  (Interventional Cardiologist):

We call this a big city procedure, and to have this done here in Mason City is very nice.

Carol Gifford (host):

It’s so exciting. Well, congratulations. And it’s exciting to have this sort of capability for the residents of Northern Iowa.

Farez Siddiqui, MD  (Interventional Cardiologist):

Absolutely, yeah.

Carol Gifford (host):

I have another question that I just want to back up. So if someone presents or has aortic stenosis or valve stenosis, is there… Like how does someone’s aortic valve get to this place? Is this lifestyle, is this genetics? Tell me a little bit more about that. And is there prevention? Because ultimately at the end of the day, you want a healthy heart. So how do people get to the point where they need this kind of procedure?

Farez Siddiqui, MD  (Interventional Cardiologist):

Yes, good question. So yes, there is a role for genetics, some people, but a very minor role. Some people are born with a defective valve, so it’s prone to getting wear and tear early on. So we see them, although this disease or condition is an old age disease, we mostly see this in 70’s and 80’s, but in that situation we tend to see a tightening of this valve as early as 40’s or 50’s. Other than that, even if the valve is a, they’re born with a normal valve, lifestyle… We don’t have good data, but it may pay or play a role. Better blood pressure control can help with the stress that the valve might have. And then mostly if they have kidney disease, kidney disease can lead to calcium buildup, which can also accelerate this process. And you might see this tightening of the valve early on.

But other than that, it’s just, there’s no proven prevention. It’s just part of growing up and getting old. And like I said people are now, especially here in the United States, we are seeing people living longer. We see more people in their 80’s, 90’s. And that’s why it’s naturally we’re seeing more and more of this condition, so it’s getting more prevalent now. Yes.

Carol Gifford (host):

And now we have a solution for it.

Farez Siddiqui, MD  (Interventional Cardiologist):

And we have a solution. [inaudible 00:11:59]. And it’s amazing. It’s one of the most, as an interventional cardiologist, it’s one of the most gratifying and satisfying procedure I can do. Like I said, they’re elderly people, but they are active. They have been active, they are functional, they are independent, but they’re very limited to what they can do. And this is, for most patients, this is like a day and night difference. In a matter of days, they feel a lot better. They can do more, they can go out on a stroll, walk outside, which they couldn’t do. They can spend quality time with their family, play with their grandchildren. So it’s amazing when I talk to them in the clinic and I see the difference. It’s remarkable.

Carol Gifford (host):

Wow, that’s terrific. That must feel so satisfying. And you were the one that was really pushing to get this procedure to mercy one in North Iowa, right?

Farez Siddiqui, MD  (Interventional Cardiologist):

Correct. It’s a team effort, of course. There’s a lot of… It’s not a one man show at all. There’s so many people that go into planning with our echo specialists, our cath lab staff, managers, nurses. And especially where we have to have a very close and working relationship with the CT surgeons. And they have a major role in this. We sit together, decide who are good candidates for what kind of therapy. And they’re with us in the procedure, helping us in case we need their help, they’re there. So it’s a team effort, and we have a great team here in MercyOne.

Carol Gifford (host):

Well thank you for being on the program and helping us understand this wonderful new procedure that’s available to Iowans.

Farez Siddiqui, MD  (Interventional Cardiologist):

Thank you. My pleasure.

Carol Gifford (host):

Thank you for listening to Mason City Docs on Call. For more episodes, go to mcclinic.com/radio-podcasts.