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Patient Ronald Wallin and wife, Rose Wallin, surgical aortic valve replacement 1/15/2013.
Patient Ronald Wallin and wife, Rose Wallin, surgical aortic valve replacement.

Aortic Valve Questions

Who will determine whether I am a candidate for Surgery or a candidate for TAVR?

Our heart team will do a full assessment to determine the best procedure for you. The heart team includes a cardiac surgeon, an interventional cardiologist and one of our Physician Assistant.

What tests will I need to have done during the evaluation?

Once you have been evaluated in our Valve Clinic, you will likely need to have the following tests to determine your eligibility:

  • Echocardiogram: will enable us to better visualize and evaluate the severity of your aortic stenosis and the size of your aortic annulus.
  • Cardiac catheterization to evaluate your coronary arteries and abdominal and pelvic arteries for any blockages.
  • CT scan of the chest/abdomen/pelvis to assess whether the arteries in these areas are large enough to deliver a valve to your heart.

Who performs the TAVR procedure?

TAVR is performed by an interventional cardiologist and a cardiothoracic surgeon working together. In our center, a majority of TAVR procedures are performed by both Dr. Kodali and Dr. Williams. Please note while Dr. Kodali and Dr. Williams most likely will perform your procedure, you may meet with other members of the team throughout the evaluation and testing process, and the follow-up care.

Are there medications I will need to stop taking prior to my procedure?

If you are taking Coumadin (warfarin sodium) for atrial fibrillation, you would need to stop the medication five days prior to the procedure. If you take Coumadin because you had a previous stroke, or a mechanical valve replacement, it will be necessary for you to take either Lovenox injections on an outpatient basis, or to be admitted to the hospital for Heparin crossover while the Coumadin affect wears off. If you are taking Pradaxa (dabigatran etexilate mesylate) for atrial fibrillation, you should stop taking the medication one to two days prior to your procedure. Surgical candidates (including those patients in the clinical trial who might be randomized to surgery) should stop taking Plavix seven days prior to their procedure. Our clinical team will provide you with full medication instructions once your procedure is scheduled. All other medications can be taken as prescribed.

Will I need to take special medication after a TAVR procedure?

If you are not currently taking a blood-thinning medication, such as Coumadin (warfarin sodium) or Pradaxa (dabigatran etexilate mesylate), after the TAVR procedure you likely will be prescribed aspirin and Plavix (clopidogrel bisulfate) for stroke prevention. Our clinical team will prescribe the appropriate doses before you are discharged from the hospital.

You will need to take prophylactic antibiotics any time you have a dental procedure other than a standard teeth cleaning. You are encouraged to contact our office in the event that you require an invasive dental procedure, so that we can inform your dentist of the appropriate preventative measures.

What kind of anesthesia is involved?

General anesthesia is required for both TAVR (with a few exceptions) and open-heart surgery. Anesthesia time is approximately one hour for a TAVR procedure and 4 to 5 hours for open-heart surgery.

If I already have a bioprosthetic (tissue) valve, can I still have a TAVR implanted?

Yes. Bioprosthetic (tissue) heart valves often degenerate over time and can eventually fail. A new technique is currently in clinical trials called “valve-in-valve” where the transcatheter aortic valve is implanted tightly into the failed valve, pushing the old valve leaflets aside. We have successfully performed quite a few of these procedures. Open-heart surgery may also be a viable treatment option for these patients.

How long have you been doing TAVR?

Over the past eight years, our team has performed more than 900 TAVR procedures, more than any other center in the United States. We have performed this procedure in some of the most medically-complicated patients.

What are the major risks associated with TAVR and open-heart surgery?

In the PARTNER Trial, patients who were high risk for surgery had similar outcomes to surgical patients. Those who have TAVR do have a slightly higher risk of stroke compared to patients who have open-heart surgery. Those who have open-heart surgery have almost double the risk of bleeding complications as compared to TAVR. Therefore, the overall risk and mortality rate is very similar for both procedures.

Do other hospitals perform TAVR?

Yes. In fact, the Columbia Heart Valve Center physicians trained close to 50 percent of the heart teams in the U.S. currently performing TAVR in their own centers.

Mitral Valve Questions

How many MitraClip procedures have the Columbia Heart Valve Center physicians performed?

We have performed close to 50 MitraClip procedures and are evaluating patients for enrollment in the COAPT Trial on a regular basis.

Why do I need to see so many physicians to determine my eligibility for the MitraClip device?

You will be required to meet with several members of our physician team including an interventional cardiologist, a cardiothoracic surgeon, and a heart failure specialist. The device may not be appropriate for all patients; therefore, it is important that we closely evaluate your medical condition and determine if your anatomy makes you a good candidate for the device. The advantage to the evaluation process is that you are followed by several heart valve specialists who will closely monitor your condition and determine the best therapy for your mitral valve disease.

How soon after the procedure can I return to my every day activities?

We recommend that patients refrain from strenuous activities for approximately 30 days post-procedure. Both surgical patients, and those who receive the MitraClip, should wait until their follow-up examination one to two weeks post-procedure before resuming every day activities.

General Questions

How long will I be in the hospital?

Evidence suggests that those who are motivated to recover tend to recover more quickly and spend fewer days in the hospital. This, of course, varies depending on the severity of a patient’s medical condition.

Those who have either mitral or aortic valve open-heart surgery can expect to remain in the hospital, on average, for 5 to 10 days post-procedure.

TAVR patients can expect their length of stay to be between 3 to 5 days for transfemeroral access, 4 to 7 days for a transaortic approach, and 5 to 10 days for a transapical procedure.

Patients who have mitral or aortic valve open-heart surgery can expect to be in the ICU for approximately 48 hours; those who have a transfemoral TAVR will be in the ICU for 24 hours. Those who have the Mitraclip device are often sent directly to a cardiac care unit and are typically discharged within 24 to 48 hours, baring complications.

When can my family visit me after my procedure?

Visiting hours in the ICU are 11:00am to 6:00pm, and 8:00pm to 10:00pm daily. Family members may visit for 10-15 minutes per hour and visits are limited to two family members at a time. Visiting hours on the patient floors, including the cardiac care floor, are 24 hours a day, 7 days a week.