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VA Palo Alto Health Care System


Artificial Valve Transforms Cardiac Care at VA Palo Alto

Cardiology team performing core valve implantation

The TAVI procedure takes a multidisciplinary team effort along with Cardiac Surgery, Anesthesiology, the Critical Care team, and Nursing.

Tuesday, May 15, 2012

Wallace Green admits he was not in the best shape when he started experiencing shortness of breath last fall and went to see his VA doctor. He was diagnosed with a severe blockage in his heart arteries, and was discovered to have a severely narrowed aortic heart valve (aortic stenosis). While usually treated with open-heart surgery, Mr. Green is an 88-year old, WWII Army Air Corps Veteran and considered a very high-risk surgical candidate. He was unsure of what he was going to do until the VA flew him from Reno, Nev. to meet the Cardiology team at VA Palo Alto Health Care System (VAPAHCS).
"The doctor and his team went over a new procedure that could be performed without even opening up my chest," said Mr. Green, who after hearing the good news, immediately started to prep by giving up unhealthy habits and getting better rest, thinking, "If the doctors can do lots of training for these procedures, then so can I."
The new procedure was an experimental procedure called TAVI (Transcatheter Aortic Valve Implantation). VA Palo Alto Health Care System was one of only 43 hospitals nationally selected to participate in this trial, and is the only VA Medical Center in the country chosen to participate.

Constructed of tissue taken from the pericardium of a pig (a thick and durable sac that surrounds the heart) which is hand sewn onto a nickel titanium supporting structure, this artificial aortic valve is delivered on a catheter tube through an artery in the leg and delivered into the narrowed aortic valve. Following implantation, there is essentially no residual obstruction across the valve.
"Our leadership has been very supportive of this effort," said Dr. John Giacomini, Chief of VAPAHCS Cardiology. "The implant really improves the quality of life for patients that are normally too sick to undergo open-heart surgery. This has been a multidisciplinary team effort along with Cardiac Surgery, Anesthesiology, the Critical Care team, and Nursing."
Mr. Green's two-hour procedure took a great deal of coordination in order to set up his flights, appointments, and lodging. After going over each step of the process and having his daughters involved in making all these arrangements, he was surprised when afterwards he was out of the hospital within three days with hardly any pain.
"It instantly improved my quality of life," said Mr. Green, "I can do so much more without running out of energy."

VAPAHCS' inclusion as a study site was a very complex process due to the need to merge government and industry policies within the framework of a large multi-center clinical trial.  It was only through the combined efforts of hospital leadership, Cardiology, Cardiac Surgery, and the Palo Alto Institute for Research and Education (PAIRE) that VAPAHCS was able to participate in this important clinical trial.

While surgical aortic valve replacement remains the standard procedure for severe aortic stenosis, rapid advances in TAVI may lead to this procedure being a viable alternative therapy, particularly in patients who are at high risk for open-heart surgery. Mr. Green was the sixth procedure done by the VAPAHCS Aortic Valve team, with several more scheduled for later this month.


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