Selected Podcast
TAVR: Transcatheter Aortic Valve Replacement
Dr. Caleb Thompson, an interventional cardiologist with Dignity Health, explains a transcatheter aortic valve replacement, or TAVR.
Featured Speaker:
Caleb Thompson, MD
Dr. Thompson graduated from the University of California, Berkeley with a B.A. in Molecular and Cell Biology and received his medical degree from St. George's University. He completed a residency in Internal Medicine at the University of California, Irvine and a fellowship in Cardiovascular Diseases at the Ochsner Heart and Vascular Institute in New Orleans. Transcription:
TAVR: Transcatheter Aortic Valve Replacement
Bill Klaproth: (Host) Transcatheter aortic valve replacement or TAVR is a minimally invasive heart valve replacement procedure that can offer new hope to patients who have aortic valve stenosis. So let's learn more with Dr. Caleb Thompson and interventional cardiologist at Dignity Health. Dr. Thompson, thank you so much for your time. It is great to talk with you, first off can you share some background on yourself?
Dr. Caleb Thompson: (Guest) Sure I was raised here in Bakersfield California and then after undergrad at Cal went to medical school at St. George's University and then started my training with an internal medicine residency at UC Irvine and then decided to do the cardiology fellowship Which was at the Ochsner Heart and Vascular Institute down in New Orleans. And that was followed by a second fellowship and interventional and structural cardiology at scripts down in San Diego
Host: You're very well-traveled Dr. Thompson.
Dr. Thompson: That's right.
Host: We like that, That's good. So can you define for us severe aortic valve stenosis and what that is?
Dr. Thompson: Sure So your heart is comprised essentially by four chambers each of those are separated by valves. The aortic valve is the last one goes through before it exits the heart. It's a Three leaflet structure and what happens with the aortic valve stenosis is sickening of those leaflets which do not allow them to move appropriately. So what happens is it becomes very difficult for blood to get out of the heart. There are different stages of aortic valve stenosis all the way from mild to severe. Mild to moderate we don't get too concerned about we just keep an eye on over the years but if someone develops severe aortic valve stenosis and that's accompanied by symptoms then we start talking about is the need for aortic valve replacement
Host: And then what are the symptoms we should know about?
Dr. Thompson: Yeah So sometimes they're very overt, sometimes they're not there They can be subtle. But things we look for certainly if someone's having angina chest pain when they exert themselves other symptoms can be breathing difficulty also usually when they try to perform some sort of activity. Some people do get dizzy and lightheaded, And the worst-case scenario is actually losing consciousness. Other folks can feel just fatiguing and had a lack of energy. The one that often causes hospitalization our heart failure symptoms People can actually develop heart failure which requires the patient to be hospitalized.
Host: Well, it's good to know and understand the symptoms. So if someone's aortic valve does require replacement. There's the transcatheter aortic valve replacement, or what's known as the TAVR, can you tell us what that is?
Dr. Thompson: Sure for decades, all we had was the surgical option which is an open chest procedure. Over the last decade or so We've been doing this new procedure called TAVR as you said, that's an alternative to surgery basically a catheter-based procedure we usually are using the artery in the groin, sometimes another artery but by and large it's the groin artery. And what we do we pass a long catheter about the diameter of one's index finger Up the aorta over the aortic arch and we actually cross native aortic valve with this catheter and either there's a couple of different companies that are manufacturing these devices but either we bluff brand new bioprosthetic valve using a balloon that's crimped onto the catheter or are we unsheathe a bioprosthetic valve-like unsheathing a sword that comes out of that catheter. Either way, we go the new valve smashes the old valve leaflets to the side and now we've got a brand new Bioprosthetic valve without the need for open-chest surgery.
Host: Which has got to make a lot of people very happy. So then who is a candidate for the TAVR procedure?
Dr. Thompson: Well at this point the year 2020 just about everyone with severe symptomatic aortic valve stenosis is a candidate. When we roll this technology out it was first for people who were at high risk for standard surgical aortic valve replacement. Then we did the studies for those who are of intermediate risk. More recently done patients Who are at low risk for any sort of surgical complication and it's been pretty consistent across the board this technology is as good and maybe even better than standard surgical aortic valve replacement. To answer your question just about everyone there are some exceptions there's certain situations where surgery is still the best option but we always want to give the patients the evaluation for TAVR because by and large, they will be a TAVR candidate.
Host: So then as people evaluate this option, what are the benefits to the patient?
Dr. Thompson: So once someone develops severe symptomatic aortic valve stenosis, we know the prognosis is not good. In fact, they are old natural history studies that show that if someone gets to that stage, a majority of those patients at the five-year Mark or no longer with us, so has a very poor prognosis once it gets to this stage. There's obviously a mortality benefit but beyond that or maybe just as important we can relieve symptoms, we can prevent heart failure and we can really improve someone's quality of life
Host: So Dr. Thompson along with the signs and symptoms is there anything else your primary care physician should be looking for when trying to evaluate your heart?
Dr. Thompson: There are signs that we can see on the exam, the most common one is that they will hear a murmur when they listen to the chest. That murmur is just the blood flow going through that narrowed valve and that's what they're hearing there so that should clue them in that that's something to investigate further. The next step in that would be what's called an echocardiogram which is essentially an ultrasound of the heart. That's how we really make the diagnosis of aortic valve stenosis. That's also how we grade it either mild moderate or severe. So an echocardiogram is an essential step in the process of not only diagnosing it but determining if someone potentially need aortic valve replacement
Host: And to get evaluated then to see if you have a murmur that starts with your primary care physician and is that generally picked up earlier in life?
Dr. Thompson: Certainly, if it's mild it may not be picked up because can be tough to hear on an exam but if it progresses to moderate-severe it's much easier to hear on exams. It may be one of those things that's brewing but not necessarily noticeable on a physical exam but certainly, when a primary physician does notice it, it can't be ignored that should always be investigated with an echocardiogram
Host: Got it and then last question Dr. Thompson and thank you for your time Is there a way to keep our heart valves healthy Someone may be listening to this going, I don't want that to happen to me, what can I do to at least maybe help ensure that I don't get aortic valve stenosis.
Dr. Thompson: Yeah and that's a good question. Oftentimes patients that we see are very healthy otherwise they've done everything they're supposed to do as far as cardiovascular health this is just one of those things as a degenerative process and develops. Sometimes people have mild or moderate aortic valve stenosis and it never rises to severe. But in general, the things we want to emphasize are obviously a healthy heart, healthy diet, and routine aerobic exercise. But if you are diagnosed with some degree of aortic valve stenosis, it's been important for regular follow-up with the cardiologist and they keep an eye on, not only symptoms, but we'll probably over the years get an echocardiogram every so often to make sure that valve is not progressing.
Host: Have a heart-healthy diet, pay attention to exercise, and then regular follow-up visits if you are diagnosed, just to make sure that it's not progressing, is that right?
Dr. Thompson: That's right. Keeping attuned to your body and symptoms. Oftentimes these are at the very incremental change over time. Sometimes people don't actually notice that they can't walk as far as they used to, or that they're getting more out of breath with things that didn't use to cause shortness of breath. Paying attention to that, and also having family there, can observe these things is important.
Host: Great suggestions, Dr. Thompson, and thank you so much for your time. This has really been informative and interesting, thank you again.
Dr. Thompson: Yeah, no problem, thanks for having me.
Host: That's Dr. Caleb Thompson. And for more information, please visit dignity health.org/bakersfield. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you. This is Hello Healthy, a Dignity Health Podcast. I'm Bill Klaproth, thanks for listening.
TAVR: Transcatheter Aortic Valve Replacement
Bill Klaproth: (Host) Transcatheter aortic valve replacement or TAVR is a minimally invasive heart valve replacement procedure that can offer new hope to patients who have aortic valve stenosis. So let's learn more with Dr. Caleb Thompson and interventional cardiologist at Dignity Health. Dr. Thompson, thank you so much for your time. It is great to talk with you, first off can you share some background on yourself?
Dr. Caleb Thompson: (Guest) Sure I was raised here in Bakersfield California and then after undergrad at Cal went to medical school at St. George's University and then started my training with an internal medicine residency at UC Irvine and then decided to do the cardiology fellowship Which was at the Ochsner Heart and Vascular Institute down in New Orleans. And that was followed by a second fellowship and interventional and structural cardiology at scripts down in San Diego
Host: You're very well-traveled Dr. Thompson.
Dr. Thompson: That's right.
Host: We like that, That's good. So can you define for us severe aortic valve stenosis and what that is?
Dr. Thompson: Sure So your heart is comprised essentially by four chambers each of those are separated by valves. The aortic valve is the last one goes through before it exits the heart. It's a Three leaflet structure and what happens with the aortic valve stenosis is sickening of those leaflets which do not allow them to move appropriately. So what happens is it becomes very difficult for blood to get out of the heart. There are different stages of aortic valve stenosis all the way from mild to severe. Mild to moderate we don't get too concerned about we just keep an eye on over the years but if someone develops severe aortic valve stenosis and that's accompanied by symptoms then we start talking about is the need for aortic valve replacement
Host: And then what are the symptoms we should know about?
Dr. Thompson: Yeah So sometimes they're very overt, sometimes they're not there They can be subtle. But things we look for certainly if someone's having angina chest pain when they exert themselves other symptoms can be breathing difficulty also usually when they try to perform some sort of activity. Some people do get dizzy and lightheaded, And the worst-case scenario is actually losing consciousness. Other folks can feel just fatiguing and had a lack of energy. The one that often causes hospitalization our heart failure symptoms People can actually develop heart failure which requires the patient to be hospitalized.
Host: Well, it's good to know and understand the symptoms. So if someone's aortic valve does require replacement. There's the transcatheter aortic valve replacement, or what's known as the TAVR, can you tell us what that is?
Dr. Thompson: Sure for decades, all we had was the surgical option which is an open chest procedure. Over the last decade or so We've been doing this new procedure called TAVR as you said, that's an alternative to surgery basically a catheter-based procedure we usually are using the artery in the groin, sometimes another artery but by and large it's the groin artery. And what we do we pass a long catheter about the diameter of one's index finger Up the aorta over the aortic arch and we actually cross native aortic valve with this catheter and either there's a couple of different companies that are manufacturing these devices but either we bluff brand new bioprosthetic valve using a balloon that's crimped onto the catheter or are we unsheathe a bioprosthetic valve-like unsheathing a sword that comes out of that catheter. Either way, we go the new valve smashes the old valve leaflets to the side and now we've got a brand new Bioprosthetic valve without the need for open-chest surgery.
Host: Which has got to make a lot of people very happy. So then who is a candidate for the TAVR procedure?
Dr. Thompson: Well at this point the year 2020 just about everyone with severe symptomatic aortic valve stenosis is a candidate. When we roll this technology out it was first for people who were at high risk for standard surgical aortic valve replacement. Then we did the studies for those who are of intermediate risk. More recently done patients Who are at low risk for any sort of surgical complication and it's been pretty consistent across the board this technology is as good and maybe even better than standard surgical aortic valve replacement. To answer your question just about everyone there are some exceptions there's certain situations where surgery is still the best option but we always want to give the patients the evaluation for TAVR because by and large, they will be a TAVR candidate.
Host: So then as people evaluate this option, what are the benefits to the patient?
Dr. Thompson: So once someone develops severe symptomatic aortic valve stenosis, we know the prognosis is not good. In fact, they are old natural history studies that show that if someone gets to that stage, a majority of those patients at the five-year Mark or no longer with us, so has a very poor prognosis once it gets to this stage. There's obviously a mortality benefit but beyond that or maybe just as important we can relieve symptoms, we can prevent heart failure and we can really improve someone's quality of life
Host: So Dr. Thompson along with the signs and symptoms is there anything else your primary care physician should be looking for when trying to evaluate your heart?
Dr. Thompson: There are signs that we can see on the exam, the most common one is that they will hear a murmur when they listen to the chest. That murmur is just the blood flow going through that narrowed valve and that's what they're hearing there so that should clue them in that that's something to investigate further. The next step in that would be what's called an echocardiogram which is essentially an ultrasound of the heart. That's how we really make the diagnosis of aortic valve stenosis. That's also how we grade it either mild moderate or severe. So an echocardiogram is an essential step in the process of not only diagnosing it but determining if someone potentially need aortic valve replacement
Host: And to get evaluated then to see if you have a murmur that starts with your primary care physician and is that generally picked up earlier in life?
Dr. Thompson: Certainly, if it's mild it may not be picked up because can be tough to hear on an exam but if it progresses to moderate-severe it's much easier to hear on exams. It may be one of those things that's brewing but not necessarily noticeable on a physical exam but certainly, when a primary physician does notice it, it can't be ignored that should always be investigated with an echocardiogram
Host: Got it and then last question Dr. Thompson and thank you for your time Is there a way to keep our heart valves healthy Someone may be listening to this going, I don't want that to happen to me, what can I do to at least maybe help ensure that I don't get aortic valve stenosis.
Dr. Thompson: Yeah and that's a good question. Oftentimes patients that we see are very healthy otherwise they've done everything they're supposed to do as far as cardiovascular health this is just one of those things as a degenerative process and develops. Sometimes people have mild or moderate aortic valve stenosis and it never rises to severe. But in general, the things we want to emphasize are obviously a healthy heart, healthy diet, and routine aerobic exercise. But if you are diagnosed with some degree of aortic valve stenosis, it's been important for regular follow-up with the cardiologist and they keep an eye on, not only symptoms, but we'll probably over the years get an echocardiogram every so often to make sure that valve is not progressing.
Host: Have a heart-healthy diet, pay attention to exercise, and then regular follow-up visits if you are diagnosed, just to make sure that it's not progressing, is that right?
Dr. Thompson: That's right. Keeping attuned to your body and symptoms. Oftentimes these are at the very incremental change over time. Sometimes people don't actually notice that they can't walk as far as they used to, or that they're getting more out of breath with things that didn't use to cause shortness of breath. Paying attention to that, and also having family there, can observe these things is important.
Host: Great suggestions, Dr. Thompson, and thank you so much for your time. This has really been informative and interesting, thank you again.
Dr. Thompson: Yeah, no problem, thanks for having me.
Host: That's Dr. Caleb Thompson. And for more information, please visit dignity health.org/bakersfield. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you. This is Hello Healthy, a Dignity Health Podcast. I'm Bill Klaproth, thanks for listening.