Heart Surgery One Day, Home the Next – Thanks to TAVR

John Plageman figured they were just symptoms of age. Sure, he was feeling some numbness in his left hand and some slight chest pain, the latter of which he chalked up to indigestion. And he couldn’t even walk to the mailbox anymore without having to stop and catch his breath. But didn’t this happen to everyone once they reached their 60s?

“I’m 67 years old, and I was thinking that this was just part of me getting older,” says Plageman, a Griffin resident.

Then his supervisor at his accounting firm suffered a heart attack after displaying the exact same symptoms, leading Plageman to consult with his cardiologist. Tests revealed his problem wasn’t due to age, but a blockage of his heart’s aortic valve that needed to be addressed immediately. Plageman was referred to Emory for a procedure with an unfamiliar name – TAVR.

“I’d never heard of it before,” Plageman says.

He wasn’t alone. TAVR – short for transcatheter aortic valve replacement and pronounced “ta-ver” – was initially used only for high-risk, elderly patients who were unable to withstand open-heart surgery.

But thanks to a series of clinical trials at the Structural Heart & Valve Center at Emory Healthcare, which has pioneered the development of the procedure, TAVR was approved for use in lower-risk patients by the FDA in 2019, making the treatment available to the broader public.

For patients like Plageman, that meant a minimally invasive procedure, the ability to leave the hospital the next day, and a quick return to normal activities – as opposed to open-heart surgery, days in the hospital and weeks of recovery.

“When they explained the TAVR to me, I was very excited, because I knew my recovery time was going to be much less,” Plageman says. “And I was also excited that this was going to help other patients in the future.”

Vasilis Babaliaros, MD, an interventional cardiologist who is co-director of the Emory Structural Heart & Valve Center, calls the development of TAVR a “huge milestone” in the treatment of heart valve disease. “These treatments lend themselves extremely well to younger patients,” he adds.

Fantasy To Reality

Doctors had been exploring the concept of using a catheter to replace heart valves since the 1980s, but they had to wait for the technology to catch up. The first successful human implant was performed in 2002 in Rouen, France, and Dr. Babaliaros was the first U.S. physician to travel to France and train under Dr. Alain Cribier, who pioneered TAVR. At that point, in 2004, the procedure had been performed on just 16 patients in the entire world.

It was a precursor of things to come at Emory. The Atlanta hospital has conducted unparalleled research into TAVR, which involves replacing the heart valve via a catheter typically inserted in the femoral artery through a small incision in the groin. In 2007, Emory was one of the principal participants in the first multicenter clinical trial examining TAVR procedures for patients too old or frail to undergo traditional surgery.

Two more trials followed, scrutinizing the procedure first in medium-risk and then low-risk patients, with that latter group receiving the green light to undergo the treatment in 2019.

“These were landmark trials,” says Dr. Babaliaros. “The Emory Structural Heart & Valve Center contributed a lot of patients and lot of expertise to these trials.”

The benefits were clear – at one year, low-risk surgical patients who received TAVR had roughly half the one-year risks of stroke, mortality and rehospitalization compared to those who underwent the much more invasive open-heart route. As opposed to days in the hospital and weeks or months of recovery, patients are eating right after the 45-minute procedure, walking around within hours, and often discharged the following day. Three days after his procedure, John Plageman was back at work.

“My recovery consisted of not lifting anything heavy for a month, and I couldn’t drive for a week,” he says. “That’s incredible. You go through this, and you’re thinking the worst about being in the hospital for two weeks, and I’m out in a day and a half.”

Emory continues to be a TAVR trailblazer through a multi-disciplinary approach to patient care that involves cardiologists, surgeons, imaging specialists and nurse practitioners or physician assistants. Emory has performed more TAVR procedures than any hospital in Georgia, including 650 last year and more than 3,000 since 2007.

“If you can figure out how to do this less invasively, the patients do better,” says Dr. Babaliaros. “In fact, that’s what they want. They want to get the procedure done and get home. Less invasive techniques, robotic techniques, and transcatheter techniques have really taken off as the technology has grown. Now we can do this, whereas before it was all a fantasy.”

Breaking a Barrier

For Plageman, who underwent his procedure in October 2019, TAVR has been the gateway back to a normal quality of life. Looking back, he realizes even his skin had taken on a pallor due to insufficient oxygen flow. He’s able to resume his regular walks, which he had been forced to eliminate due to shortness of breath. He’s looking forward to his annual hunting trip to Wyoming, which he had to cancel last year on the advice of doctors.

Although TAVR is used to repair aortic valves, Dr. Babaliaros says researchers are working on similar approaches for mitral and tricuspid valves, which are trickier, he notes, because of their location between heart chambers that are actively beating. Transcatheter valve replacement has also solved a lot of problems for younger patients with congenital heart disease, specifically pulmonary valve disease.

“TAVR has broken a barrier for us,” says Dr. Babaliaros. Thanks to Emory research, and the research of major academic centers around the U.S., a treatment once reserved for the frail and elderly is now saving and bettering the lives of a much broader patient base. Just ask John Plageman, who’s still amazed he was up and walking the floor with his IV bag just hours after undergoing the procedure.

“The feeling was amazing,” he says. “I couldn’t believe that I’d just had heart surgery.”