Heart disease claims the lives of 600,000 individuals annually, the largest
health threat for men and women in America. Torrance Memorial Medical
Center has established a world-renowned team of cardiac physicians; each
specializing in unique procedures, techniques and heart conditions. Join
us as we discuss with Salman M. Azam, MD about the
Transcatheter Aortic Valve Replacement (TAVR) technique.
Heart Hero: SALMAN M. AZAM, MD
Can you explain what the Transcatheter Aortic Valve Replacement (TAVR)
technique is and who benefits the most from it?
TAVR is a procedure approved in the past couple of years that allows the
Torrance Memorial cardiologists and cardiac surgeons to come together
as a team and offer a cutting-edge treatment option to patients with severe
symptomatic aortic stenosis. Simply put, this procedure involves mounting
a bioprosthetic valve on a balloon catheter, which is delivered via one
of three different access sites to the patient’s stenotic aortic
valve and deployed inside the native valve, pushing the patient’s
own valve leaflets to the side. The end result is a fully functioning
bioprosthetic aortic valve, making it significantly easier for the heart
to pump blood to the rest of the body.
Amazingly this procedure is performed on a beating heart, unlike traditional
surgical aortic valve replacement, which involves stopping the heart from
beating (circulatory arrest) and using a cardiopulmonary bypass machine.
This procedure is currently approved by the FDA for patients who are at
high risk or inoperable candidates for traditional surgical aortic valve
replacement, placing them at very high risk for mortality over the next
one or two years. This procedure provides new hope and treatment options
for patients where none existed previously.
Is there ever an ethical issue when choosing patients to undergo TAVR?
The evaluation process for TAVR is complex, and the goal is to provide
treatment options for patients who will derive mortality benefit and an
improved quality of life. At times it is difficult to evaluate patients
with multiple severe medical illnesses in addition to severe symptomatic
aortic stenosis. When other severe medical problems exist—for example,
active cancer or end-stage lung disease—it is very important to
assess whether the patient’s mortality rate will remain high even
after treatment of the aortic valve stenosis.
In such cases, it is unethical to put a patient through an invasive aortic
valve procedure and hospitalization when in fact the patient will not
derive a meaningful benefit. Such ethical scenarios are addressed at our
multidisciplinary conferences where a team decision is made regarding
pursuing an invasive treatment strategy or more conservative management.
YOUR OTHER HEART HEROS: Michael Wyman, MD |
Sang Yong Ji, MD |
Jack Sun, MD |
Christopher Matchison, MD | Salman Azam, MD |
John Stoneburner, MD