Transcatheter Aortic Valve Replacemen (TAVR)t at SVMH

Dr. Zetterlund discusses Transcatheter Aortic Valve Replacement (TAVR).
Transcatheter Aortic Valve Replacemen (TAVR)t at SVMH
Patrik Zetterlund, MD
Patrik Zetterlund, MD is a SVMC Central Coast Cardiologist. 

Learn more about Patrick Zetterlund, MD

Scott Webb (Host):  Transcatheter aortic valve replacement also known as TAVR is a minimally invasive surgical option for patients suffering from aortic stenosis. And I’m joined today by Interventional Cardiologist, Dr. Patrik Zetterlund. He refers to himself as a plumber but there’s a little more to it and he's going to explain it all to us today. This is Ask the Experts, a podcast from Salinas Valley Memorial Healthcare System. I’m Scott Webb. Doctor, thanks so much for joining me today. You are an Interventional Cardiologist and I’d love to know exactly what does that mean? What do you do on a daily basis?

Patrik Zetterlund (Guest):  Well I’m a plumber, essentially. I take care of blocked arteries and valves by intervention that is we intervene, and we address them for the purpose of treating them now and this could be coronary arteries, it could be peripheral arteries, it could be the arteries up into your brain and arteries in the gastrointestinal tract. That’s what an Interventional Cardiologist does. He intervenes and treats these arteries.

Host:  Got it and so great that you think of yourself as a plumber. We all need a plumber now and again for our homes of course and then obviously our hearts and that’s what we’re here to talk about today. Let’s start with this. What is an aortic stenosis?

Dr. Zetterlund:  That is a term that we use medically for describing a valve that is the outflow valve or the aortic valve when it becomes hardened and it has not the ability to open and adequately allow blood flow into the body.

Host:  And is aortic stenosis fatal?

Dr. Zetterlund:  If the aortic stenosis progresses to a severe extent and you become symptomatic, it is ultimately a fatal condition.

Host:  Okay so then now as you were explaining before that you are an Interventional Cardiologist, meaning you intervene; let’s talk about that intervention. Let’s talk about TAVR. What is TAVR? We know it’s transcatheter aortic valve replacement but what is that? What does that mean?

Dr. Zetterlund:  Well it’s a new novel approach to treat aortic stenosis. That is traditionally when people think that they need surgery to address their aortic stenosis they have to have an open heart surgery be put on bypass, it will be general anesthesia and spend a week in the hospital. We can address this same problem by going through the groin, percutaneously with a small catheter and snake up into the heart and do it under light general anesthesia and generally the patient can go home the next day.

Host:  That is truly amazing and when did SVMH start conducting TAVR procedures and how many patients so far?

Dr. Zetterlund:  Well we started perhaps as some people say, late in the game because we want to make sure that this was the right thing for the patients. So, we are in our second year of the TAVR program here at Salinas Valley Memorial Hospital and we have done nearly 60 patients.

Host:  Wow, 60 so far. That seems like a lot to me in two years but maybe that’s kind of par for the course. Where do you perform these procedures? Is it an operating room or the cath lab?

Dr. Zetterlund:  We actually use the cardiac catheterization laboratory. Keep it in mind though that this catheterization laboratory has been upgraded to what we call a hybrid room that is it can also perform certain surgical procedures. So, it’s not just standard cardiac catheterization laboratory, it’s truly a state of the art upgrade that has been instituted as part of this program.

Host:  Yeah, it’s one of the things I love about SVMH is it’s always trying to be on the cutting edge state of the art which is so great. Can you break down the procedure just a little bit more. I know it’s minimally invasive and you talked about percutaneous going in through the groin, but maybe just take us through that in a little more detail.

Dr. Zetterlund:  After the patient has been recognized to be an appropriate candidate to have it done by the minimally invasive procedure, and it’s truly a team effort; the patient is brought to the cardiac catheterization laboratory and put under light general anesthesia and we put people under general anesthesia not so much because they need to asleep but they need to be absolutely still. Because remember, I am changing a valve on a running engine. So, then we access through the skin without any surgery, just this little catheter in through the artery in the groin and we then snake up into the heart. We get across the valve and we actually literally take the valve, and we break it apart and push it up against the wall. So now you have a wide open conduit. At that point, we actually arrest the heart briefly for a few seconds and we insert the valve, and the valve is actually spring loaded like a Chinese Checker and we let go and the valve pops in to position. We start up the heart again. And that’s it.

Host:  It is amazing to hear experts like yourself who do this on a daily basis talk about it so matter of factly. That well we arrest the heart briefly and it’s just amazing to me that you can do that so easily and talk about it so matter of factly. It’s really incredible. How long does the actual procedure take?

Dr. Zetterlund:  The actual what we call skin to skin, that is where I actually introduce the catheter into the body and then come out and put a little stitch and close so that between 30 and 40 minutes.

Host:  So, that’s pretty amazing as well that the procedure is relatively short. Who is a good candidate for TAVR? Does age matter?

Dr. Zetterlund:  I would rephrase that question and say who is not a good candidate for TAVR. When it initially started and it was experimental and under research, the surgeons would only give us the really sick people that they were scared to do surgery on. And we proved to them that we did a better job and then we started doing moderate risk patients and now we do low risk patients, that is they would do really well with surgery, and we can still beat the surgeon on complication outcomes on a low risk patient. So, there’s very rare that we don’t see anyone that’s not a candidate. I would say that at Salinas we probably close to 90% of people that have aortic valve problems will get the minimally invasive procedure.

Host:  Well that’s good to know and so who and how is the decision made then when TAVR is indicated that it would be performed on a patient?

Dr. Zetterlund:  The key here is it’s a team effort. We have the referring cardiologist that will refer the patient to the TAVR team. And the TAVR team includes myself, only as the principal operator, but it also includes the surgeons. So, the patient is seen by the referring cardiologist and seen by myself, seen by the surgeon and then the data that we generate both by truly reconstruction of the valve and the person’s anatomy and also invasive studies are then all sent off to a third party also for documentation of appropriateness and then we meet in what we call a TAVR panel and this panel looks over all the information and we make a collective decision that this is an appropriate candidate.

Host:  Let’s talk about recovery time. You mentioned that they – most patients can go home the next day. But what’s the recovery time and when can people resume normal activities such as exercise or maybe even other strenuous activities?

Dr. Zetterlund:  Usually the patient spends one day in the hospital. That is they have the procedure in the morning and they generally sit up at lunch time and have lunch and walk around and then discharged the next day. And I tell them they can drive the car the next day if they want to. They can resume regular activities within the next 24 to 48 hours.

Host:  Let’s talk about the point person. If somebody wants to learn more or thinks that they might be a good candidate for TAVR; whom should they contact, what’s the phone number?

Dr. Zetterlund:  Ann Timberlake is our structural heart coordinator at Salinas Valley Memorial Hospital, and she can be reached at area code 831-759-1992.

Host:  I know you have a close relationship with her. You are one of the people who interviewed her and brought her in and as you said earlier, she kind of keeps you on the straight and narrow which is great. As we wrap up this portion about TAVR, anything else you want the community to know about TAVR?

Dr. Zetterlund:  The TAVR is a new novel way to afford a patient to have a very safe and effective procedure that can prolong their life by more than a decade or two. And the complication rate of a TAVR runs at least as low as an uncomplicated surgery and in many cases even lower. And the life quality benefit is tremendous, and we see individuals in their 90s that certainly would not have been a surgical candidate, have many years of quality of life.

Host:  That’s great. That’s what it’s really all about is helping people live longer and improving their quality of life and let’s shift gears here a little bit as we begin to wrap up here about COVID-19. We know that during the pandemic, sort of another pandemic has reared it’s head there in Salinas Valley and Monterey that people are afraid to go to the ER despite that they’ve been told that it’s safe and everybody is wearing PPE and SVMH is on the cutting edge of all of this; people are afraid of being infected by COVID-19 and so what’s happening is people who have emergent conditions, stroke, heart attacks, things like that; they’re just simply not calling 9-1-1. They’re not going to the doctor. So, as an Interventional Cardiologist, what do you want people to know? What’s your message to them about how damaging a heart attack can be even a minor heart attack and why we need them, if they think they’re having a problem call 9-1-1, get to the hospital.

Dr. Zetterlund:  Absolutely. Absolutely. If you have any symptoms that is remotely resembles anything wrong with your heart; please call 9-1-1 and come to the emergency room. The emergency room is safe. We have appropriate measures for limiting exposure to the virus. Myself as a physician, I go to the emergency room almost on a daily basis and see people with COVID and not COVID with appropriate PPE protection. There is no reason why you shouldn’t go to the emergency room if you think you have a problem with your heart.

Host:  That is a great way to end and I loved having you on today Doctor. You have an amazing way of kind of cutting right to the chase and getting to the heart, no pun intended of the matter. You really have an amazing way of explaining some fairly complex things, explaining it in such a way that it hopefully will benefit people that they’ll be easy to understand and again, if they’re having a problem, or they want to know more about TAVR, anything, call 9-1-1 or call Ann Timberlake at 831-759-1992. They may end up seeing the plumber, may end up seeing the Interventional Cardiologist but in the meantime, thank you so much for your time and you stay well.

Dr. Zetterlund:  Oh you too. You’re truly welcome. It was my pleasure.

Host:  Again for more information on TAVR please call Ann Timberlake, the TAVR Program Coordinator at 831-759-1992. And we hope you found this podcast to be helpful and informative. This is Ask the Experts from Salinas Valley Memorial Healthcare System. I’m Scott Webb. Stay well and we’ll talk again next time.