Transcription:
Valve Disease and the New Medical Frontier

Deborah Howell (Host): Hello, and welcome to the show. You're listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Dr. Rex Winters, Medical Director of Invasive Cardiology in MemorialCare Heart and Vascular Institute at Long Beach Memorial. Board certified in internal medicine, cardiology and interventional cardiology, Dr. Winters centers his practice on both in-patient and out-patient care while encompassing the diagnosis and treatment of coronary and peripheral vascular diseases. Welcome, Dr. Winters.

Dr. Rex Winters (Guest): Thank you, Deborah.

Deborah: Today we're going to talk a bit about valve disease and the new medical frontier, and I for one am looking forward to it. Let's begin at the beginning. What exactly is heart valve disease in a nutshell?

Dr. Winters: Sure. Valvular heart disease, encompasses a number of cardiovascular disorders, actually. They involve the progressive deterioration of the major valves of the heart. These valves are thin tissue structures that allow the heart to segmentally move blood through the heart and lungs and into the rest of the body.

Deborah: Okay. That was a great nutshell. What are the signs and symptoms of valve disease?

Dr. Winters: Well, to some extent, it depends on which valve is affected. But it can range from fatigue to sudden cardiac death. The more common symptoms include shortness of breath, chest pain, lightheadedness, or even transient loss of consciousness.

Deborah: Really, just lightheadedness?

Dr. Winters: Yes. Mild lightheadedness is one of the common symptoms of patients who have narrowed valves.

Deborah: Now, is there a difference between lightheadedness and dizziness?

Dr. Winters: Certainly. There's a whole spectrum of neurological diseases and other types that involve vertigo and positional lightheadedness. They're different from the kind of lightheadedness here. This lightheadedness is more of a very short-lived, several seconds loss, like you're going to pass out or be unbalanced. It is very, very transient and then resolves again within seconds.

Deborah: I know with the elderly, they always asking the question, "Are you dizzy, or is it lightheadedness?" and maybe that's why.

Dr. Winters: Yeah. The dizziness is a little bit different, but all these are relatively ill-defined. And certainly, any patients suffering from either moderate to severe dizziness or lightheadedness should have a cardiovascular workup, not just for valve or heart disease but there are whole hosts of other disorders involved with the cardiovascular system that could be applied.

Deborah: That leads me to my next question. Who does valve disease typically affect?

Dr. Winters: Well, depends on the specific valve effect and, to some extent, whether the disease is congenital—patients that are born with it or acquired. For example, one of the most common valve disorders that we face is aortic stenosis, which is a narrowing of the heart valve that the valve is positioned between the heart muscle and the rest of the body. And if that cause is congenital, patients will centrically present with those symptoms I mentioned earlier in the third or fourth decade of life in contrast to an acquired aortic valve problem, where patients typically present over the age of 65.

Deborah: When you were talking, I just put something together. I think I might have put something together: stenosis and stent.

Dr. Winters: So very similar, in a way, to what we've been doing with coronary disease and vascular disease, where there is a blockage in an artery obstructing blood flow. We have been placing stents now for decades. The newer technologies that are coming out for narrowed valves also involve these valves being placed within a stent structure and a stent placed within that valve for repair.

Deborah: Now, when you talk about stent, are you talking about balloon stents or what type of stent?

Dr. Winters: Well, it depends upon the type of valve that's being placed in. We have both. We have valves that can be placed with a stent only, and then a balloon used afterwards to expand the stent into its position. Then we have valves that are loaded into stents that do get loaded with balloons, like you had mentioned, up front, and that's how they get positioned in those areas of damaged heart valves.

Deborah: Fantastic. Can you tell me a little bit more about the treatments available at the MemorialCare Heart and Vascular Institute at Long Beach Memorial?

Dr. Winters: Sure. At the Heart and Vascular Institute at Long Beach Memorial, we not only offer standard surgical options but have been for a while on the forefront of valve therapy with robotic valve repair and minimally invasive valve replacement. We now are moving forward specifically for stenosis for an even lesser invasive approach called TAVR.

Deborah: Okay. That's TAVR?

Dr. Winters: TAVR.

Deborah: Okay. And what is the TAVR procedure for heart valves?

Dr. Winters: This TAVR procedure, which stands for Transcatheter Aortic Valve Replacement, is a technique that offers certain patients suffering from aortic stenosis a less invasive therapy compared to the standard surgical replacement.

Deborah: Okay. Less invasive meaning...?

Dr. Winters: I'll just explain it to you in brief. Typically, a TAVR procedure involves placing a new heart valve through especially designed catheters that are placed to the major artery in the leg, and then into the heart, across the damaged valve, and then put into position with that balloon technique that you had referenced earlier. That heart valve is secured in place, and then all the catheters are removed. This allows us to avoid major incisions in the chest, and/or the use of cardiopulmonary bypass machines that both carry high risk of infection and stroke and even death.

Deborah: How new is this procedure?

Dr. Winters: It's been around in Europe and very southern places outside the US for a number of years. We've had FDA approval here for about 3 years now, and have evolved into putting a program in place with the training and putting the physician and other allied healthcare staff team together over the last year and a half, and are getting ready to launch our program at Long Beach Memorial within the next 48 weeks in our new Hybrid Suite.

Deborah: As a physician and as a surgeon, how exciting is the TAVR?

Dr. Winters: It's exciting because we mainly can offer patients that otherwise would have no therapy offered to them a better quality of life and, to some extent, lower mortality rates. There's a number of patients out there with valvular heart disease that are too high of surgical risk to even get therapy, and this procedure has certainly has been proven to be very effective and better for those patients than high-risk surgical procedures.

Deborah: Who's the typical TAVR patient?

Dr. Winters: The typical TAVR patient is somebody who has a severe narrowing in the aortic valve position, primarily right now, and that are either high risk for standard surgical valve repair and/or out of surgical candidate at all. So they typically would be somebody who has other multi-medical problems that makes surgery a high-risk procedure and/or the elderly, who just can't tolerate the stress of a full standard surgical procedure.

Deborah: Right. Did you say I'm not doing any more surgery?

Dr. Winters: We've heard that time and time again with our TAVR patients, but they're very happy once the TAVR is done, that they can do more things with less shortness of breath and a higher quality of life.

Deborah: They go in, how are they feeling, and then how are they feeling after the TAVR?

Dr. Winters: Well, I guess specifically for this disease, let's say, aortic stenosis that I've referenced, this is a disease that progresses over a number of years. So patients have gotten used to working at a lower and lower activity rate and are fairly deconditioned. So they come in feeling tired and fatigued and short of breath. The TAVR procedure is a couple hours for the procedural part. Patients will stay in the hospital as little as two days usually not more than five. And by the time they're home, they're actually doing things without shortness of breath, with much more energy, and feeling much better about their quality of life.

Deborah: It's a happy day.

Dr. Winters: Yes, days. Not just one.

Deborah: Yeah. Now, how is this Hybrid Suite that I've heard about helping you with patient care?

Dr. Winters: Yes. The Hybrid Suite is a specially designed suite that allows us to perform either surgical or interventional procedures, either individually or in combination between the surgeons and myself, interventional cardiologist, in a so called hybrid procedure. This room is specially designed, both in space and configuration as well as the high-end imaging equipment to be able to do these kinds of procedures and others. They allow both the interventional cardiologist, this cardiothoracic surgeon, the vascular surgeons to work side by side, allowing us then to offer more definitive therapies for things such as valvular heart disease with less invasive techniques but yet still get high-quality clinical outcomes.

Deborah: Okay, so hybrid meaning more than one application or... what is hybrid?

Dr. Winters: Hybrid meaning the combination, if you will, of surgical and less invasive interventional techniques. So, some mild surgery are used, for example, to get the catheters in placed, but yet no major surgery is used, and interventional techniques take over in order to complete the procedures like the TAVR.

Deborah: I see. So it's not a traditional ER at all?

Dr. Winters: No. It's a combination of an operating room and a high-end interventional procedure suite, where things like coronary stents and those things are being put in them.

Deborah: Awesome. And it's such a brand new day, isn't it?

Dr. Winters: It's a bright day.

Deborah: How long have you've been doing these procedures yourself?

Dr. Winters: Well, I've been doing these procedures going on two years now. We've been working hard to make sure that it will be a new procedure, that we've had access to actually using the device; patients, direct patient care and direct procedural experience. I've worked with a number of folks here in the south and several of my colleagues up in Los Angeles to perform now close to a hundred of these procedures over the last year and a half to two years, and it's really been something where we feel we're finally at the point where we've gotten through all the learning curves and we're ready to offer this therapy to the patients.

Deborah: Thank you so much, Dr. Winters. It's been great to have you on the program today.

Dr. Winters: I appreciate the time. Have a great day.

Deborah: Thank you so much, sir.