Jefferson University Hospitals

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TAVR Information for Referring Physicians

Aortic stenosis affects nearly 6 million people worldwide. Without replacement therapy, patients have a greater risk for mortality. At Jefferson Health, our TAVR team has the expertise needed to create a personalized care and advanced treatment plan. Our goal is improving your patient’s quality of life.

The Jefferson Health Difference

Jefferson Health provides a holistic team approach in order to identify a personalized treatment program. Our TAVR team consists of a cardiothoracic surgeon, interventional cardiologist, echo cardiographer and anesthesiologist.

When your patient begins his or her TAVR treatment journey, they’ll have access to experienced providers who are known experts in the field of cardiology. Our various anesthesiology options help promote quicker recovery time. Moderate Anesthesia Care (MAC), commonly referred to as “conscious sedation” has been studied and is a safe and effective way to undergo the TAVR procedure.  It is available for approximately 45 percent of the overall TAVR population who meet specific criterion. 

Patients will be happy to learn that they’ll spend less time in the hospital and more time getting back to life.

Outcomes

TAVR has become an alternative for patients who cannot otherwise undergo open surgical valve replacement surgery. Three large, multicenter trials in the United States and Canada have shown TAVR safety and efficacy, which led to its FDA approval.

The SAPIEN 3 observational study, published in The Lancet in April 2016, showed TAVR was the superior alternative treatment for 1,077 intermediate-risk patients. After one year, researchers found lower rates for all-cause mortality, stroke, and the composite endpoint of morality, stroke and moderate or aortic regurgitation, but higher rates for moderate or severe regurgitation. Specifically, the results showed:

•             7.4 percent of patients died

•             2 percent had disabling strokes

•             1 percent had aortic valve re-interventions

•             2 percent showed moderate or severe paravalavular regurgitation

Additional research has shown that TAVR has led to an 11 percent rate of hospital readmission after the procedure, and a 12 percent rate of requiring a pacemaker after the procedure. Patients who undergo TAVR tend to have a shorter hospital length stay than those who undergo surgical valve replacement surgery, spending just four days in the hospital, on average. What’s more, 94 percent of patients report symptom improvement and maintain symptom-free one year after TAVR.

Does My Patient Qualify?

TAVR is only approved for patients with inoperable, intermediate or high-risk aortic stenosis. Though there are general practices and guidelines when evaluating a patient for TAVR, we are more than happy and available to discuss your patients’ options.

Who Can I Contact for More Information?

Referral to a TAVR clinic is appropriate at the time of diagnosis in order to help prevent consequences of heart failure. If you would like more information or would like to determine if TAVR is appropriate for your patient, please call Rebecca Marcantuono CRNP, our heart valve coordinator, at 215-955-2918.

To refer your patient for an appointment, please call 1-800-JEFF-NOW (800-533-5669).

References

Marcantuono R, Gutshe J, Burke-Julien M., et al. Rationale, Development, Implementation, And Initial Results Of A Fast Track Protocol For Transfemoral Transcatheter Aortic Valve Replacement (TAVR). Catherization And Cardiac Interventions. 2015. Volume 85, Issue 4, 654-648. 

Thourani VH, Kodali S, Makkar RR, Herrmann HC, et al. Transcatheter Aortic Valve Replacement Versus Surgical Valve Replacement In Intermediate-Risk Patients: A Propensity Score Analysis. The Lancet. 2016: 387, 10034 (2218-2225). DOI: 10.1016/S0140-6736(16)30073-3.

Tang G, Feng C, Ahmad H, et al. An “All-Comer” Minimalist Approach To Transcatheter Aortic Valve Replacement Is As Safe And Effective As The Traditional Approach. J Am Coll Cardiol. 2016;67(13_S):414. DOI: 10.1016/S0735-1097(16)30415-6.

Wood, D.A. et al. A Multidisciplinary, Multimodality, But Minimalist (3m) Approach To Transfemoral Transcatheter Aortic Valve Replacement Facilitates Safe Next Day Discharge Home In High Risk Patients: 1 Year Follow Up. Canadian Journal Of Cardiology. Volume 30, Issue 10, S130.