Dr. Rania Habib (Host): This is Community Connect presented by TGH. I'm your host, Dr. Rania Habib. Today, we are joined by nurse navigators, Jennie George and Lori Gicker, at Tampa General Hospital. Jennie and Lori, welcome to the podcast

Lori Gicker: Thank you for having us.

Jennie George: Good afternoon.

Host: Lori, I'd like to begin with you. What is aortic stenosis?

Lori Gicker: Aortic stenosis is a narrowing or calcification of the aortic valve. Sometimes this narrowing keeps the valve from opening fully, reducing blood flow to the rest of the body, and making the heart work harder. Sometimes when you visit your doctor, he can see symptoms by listening to you and hearing a murmur, or sometimes you might have symptoms such as chest pain, fatigue, shortness of breath. Mild cases do not need treatment, but in some severe cases, surgery or minimally invasive procedure can repair the valve.

Host: Thank you for that introduction. Jennie, how is aortic stenosis diagnosed?

Jennie George: Well, typically, when you go to the doctor, they might tell you you have a murmur. and when they tell you have a murmur, a lot of times they'll order what's called an echocardiogram. And the echocardiogram will give you the definitive diagnosis of where that murmur is coming from. Once that report gets taken back to your primary care doctor, then they will refer you to a cardiologist.

Host: So Lori, let's say for example, my doctor says I have a heart murmur and I undergo the echocardiogram that Jennie mentioned and my results confirm now that I do indeed have aortic stenosis. What are my options for treatment?

Lori Gicker: Well, it kind of depends on the severity of the aortic stenosis, and your cardiologist can decide the severity of the stenosis. So if it's not severe, and you don't have symptoms, your cardiologist can continue to monitor your aortic stenosis by doing echocardiograms every six months. And if it's not severe and you're having symptoms, you can come to Tampa General and we can evaluate the severity of the aortic stenosis.

If it is severe, then you can come to Tampa General and we would be able to have it evaluated and see the opportunities we have at Tampa General to repair the valve. You could either have an option of open heart surgery or possibly, we have a minimally invasive approach called a TAVR.

Host: So, let's say my doctor wants me to be seen at Tampa General Hospital for the minimally invasive procedure that you mentioned. It's also known as a transcatheter aortic valve replacement or TAVR. What are the next steps? Jennie, I'd like you to answer that one.

Jennie George: So, there are a couple of different ways that the doctor can refer you. They can call our phone number, which is very convenient. It's 813-844-TAVR. And there's also an email, which is called hvicreferral@tgh.org. That's hvicreferral@tgh.org. A lot of times a lot of these cardiologists know somebody at Tampa General, so sometimes they do give that physician a phone call and then they'll contact us.

Host: Now, Lori, if I'm determined to be a candidate for a T-A-V-R, a TAVR. How do I get scheduled and what should I expect at that first visit?

Lori Gicker: Well, once the referral is received by our team, one of our team members will reach out to you and let you know we received your referral. Kind of go over your medications and your history and get records if needed. And then, they pass it on to Jennie or myself, the nurse navigators. And then, we call you, talk to you, review your symptoms, set up any additional testing needed, and then set a clinic date to come and meet with the Interventional Cardiology team to assess your aortic stenosis.

Host: Now, who's present at that first visit?

Lori Gicker: So, we have the interventional cardiologist, the nurse practitioners, the nurse navigators and then a cardiothoracic surgeon also meets with you. We approach the evaluation as an interventional team. And that way, you see somebody who does surgery and then that's a cardiothoracic surgeon and then an interventional cardiologist that's a doctor that performs the TAVR and they decide as a team if you would need a surgical approach or if you would be a candidate to do the minimally invasive approach.

Host: Wonderful. Now, Jennie, our listeners might not know what a TAVR actually is. Could you describe what a TAVR is, a transcatheter aortic valve replacement, and highlight some of the risks of having a TAVR?

Jennie George: So, it is a minimally invasive procedure where we typically go through your groin, and we will do testing to see if you're a candidate for that. It has been around in the United States for about 12 years because most people who are diagnosed with aortic stenosis have had too many birthdays. So, they're not a candidate for open heart surgery, which was typically the only way to fix your aortic stenosis. So if they weren't a candidate for open heart surgery, then unfortunately they would die from aortic stenosis. So, they came out with this minimally invasive procedure. We would do a CAT scan to determine if you're a candidate, if your vessels are large enough to handle the catheter, which is as simple as something like a heart catheterization if a patient has ever had one of those.

And then, there's risks of course with any procedure. This one is very safe. And the biggest risk is getting a permanent pacemaker. Other risks, small risks would be bleeding at the groin sites or developing a hematoma or getting it infected in that area.

Host: Now, Lori, compared to open heart surgery, what are the benefits of having a tAVR?

Lori Gicker: When we deal with patients being evaluated for aortic stenosis, we have a population usually between the ages of 60 and 95. So, the younger population, we consider 60 to be the younger side of our population that we deal with, there's pros and cons for both procedures. But the pros for having TAVR when you're an older patient, I would say 75 to 95 year old, quicker recovery, no open chest, easy access through the groin, quick recovery time, go home the next day, instead of being hospitalized for a week. And the biggest thing would be no heavy lifting for five to seven days. So, those are the pros to definitely having a TAVR over having the surgical procedure.

Host: Jennie, let's say I've had a TAVR procedure. How long should I expect to stay in the hospital? And can you also go over what are my limitations?

Jennie George: The best part about having a TAVR is your length of stay in the hospital is very short. So typically, we have you come in the morning of your procedure. You will have the procedure, which takes approximately one to two hours. You will stay the night. They will repeat an echocardiogram the next day. As long as everything looks good, the patient will be discharged home, usually between 11:00 a.m. and 1:00 p.m. the next day. We did talk about that risk of getting a pacemaker. if they do need a pacemaker, they typically would go the very next day for the pacemaker and then go home the next day. So, one day if they do not need a pacemaker, two days if they need a pacemaker.

And limitations are for about seven to 10 days after you have your aortic valve replaced. We will have you follow up with our nurse practitioner, Sarah. And we ask that they don't lift anything heavy. I say nothing greater than a gallon of milk. No submerging in water because they did go through your groins and we don't want that to get infected. No squatting because they did go through a pretty large vessel in your groin and we want that to heal appropriately. And then, they can shower and exercise as normal though. So, that is a benefit of a TAVR, because usually the TAVR valve makes the patient feel better very quickly because it starts working immediately.

Host: That is incredible. Now, you did mention, you know, avoiding lifting heavy things and the squatting. How long is that limitation?

Jennie George: Seven to ten days. And for sure, the nurse practitioner, when you do a follow up with her and will clear you at that time.

Host: That's wonderful. It's such a short recovery. I love that. Now, Lori, let's say I've had a TAVR. Could you describe my followup care?

Lori Gicker: Once you leave the hospital the next day, we will make your appointments for you. You will have a one to two-week followup with our nurse practitioner, Sarah. Sometimes, we arrange this with the primary cardiologist, depending on the patient. Then, we always do a 30-day followup echo and a one-year followup echo. And then, Jennie or myself call you after the 30-day and the one-year echoes to review the results, see how you're feeling, how everything's going. And we also keep in touch with the patient. Jennie and I make ourselves accessible at all times. Just in case there's any changes or anything you would like to discuss with us, we're always available to the patient to answer any questions or concerns they may have.

Host: That is fantastic. I love the fact that it's a real multidisciplinary approach at your clinic.

Jennie George: Yeah. And a lot of times when we have them follow up with their primary cardiologist, the beautiful thing about that is, is patients can come from anywhere. So, say, they live down in Fort Myers and they want to come to Tampa General to have their procedure, but they don't want to keep coming back for followup appointments. So, that's when we can make their followup appointment with their primary cardiologist. They're one to two weeks and we can also schedule their echoes close to where they live. So, they come here basically to meet the team of doctors for their initial visit. Then, they come back for their aortic valve replacement. And then, basically, they can do the rest of their followup close to their home.

Host: That is fantastic. You really make it easy for the patient.

Jennie George: That's our goal.

Host: Now, Jennie and Laurie, you have provided wonderful information about aortic stenosis and your amazing clinic with us. Finally, I'd love for each of you to leave any best practices or recommendations for a safe recovery. Jennie, let's start with you.

Jennie George: So, I think one of the biggest things is making sure you follow all the followup instructions that we give you. A lot of times you will go home on some additional medication, depending on the interventional cardiologist and how long he'll keep you on that medication. Usually, it's about one to three to possibly six months. And just to make sure that you listen to your body and increase your activity as needed. We also recommend if it debilitated you at all to do a cardiac rehab and we can help you get set up for that also and provide a referral.

Host: That's fantastic. And Laurie, what's your final message to our audience?

Lori Gicker: I'm going to agree with Jennie, try to get active as much as possible, as much as your body will allow post TAVR procedure. Also, I think it's a good idea to monitor your blood pressure, keep a log of that for your followup appointments, report to Jennie or myself any changes that may occur after you have your procedure. And like Jennie said, listen to your body, enjoy your new valve and the symptoms being relieved. I hope that lets people get back to the quality of life that they're looking for.

Host: Wonderful. Thank you both for joining us today.

Lori Gicker: Thank you for having us.

Jennie George: Yes, thank you. Hopefully, this will give some good insight on our program and aortic stenosis.

Host: Once again, that was nurse navigators, Jennie George and Lori Gicker at Tampa General Hospital.

For more information, please visit tgh.org/heart. If you enjoyed this episode, please be sure to like, subscribe, and follow Community Connect, presented by TGH, on your favorite podcast platform. I'm your host, Dr. Rania Habib, wishing you well. This is Community Connect, presented by TGH. Thanks for listening.