October 2015, marked the initial Transcatheter Aortic Valve Replacement procedure  performed at Phoebe which offers severe aortic stenosis patients, who are either  high-risk or deemed inoperable for open heart surgery, an effective alternative treatment.   This minimally-invasive team-based procedure requires the active participation of both an interventional cardiologist and a cardiovascular surgeon.

Phoebe is the only hospital in South Georgia that offers the TAVR procedure. Only ten hospitals in the state, of which seven are located in or north of Atlanta, one in Augusta and one in Savannah, provide this advanced procedure.

“Phoebe has a longstanding tradition of bringing new and innovative care to our region. Our advanced heart program is one of the oldest and most experienced in the region having introduced open heart surgery, cardiac catheterization, electrophysiology and a long list of advanced procedures to South Georgia,” noted Phoebe Putney Health System President/CEO, Joel Wernick. “The addition of the TAVR program has required significant commitment and investment from both our division of cardiology and cardiovascular surgery. We have assembled an exceptional heart valve team and are delighted to now offer this minimally invasive procedure for high-risk patients with severe aortic stenosis.”

Khaja Mohammad, MD, interventional cardiologist, and Anthony Hoots, MD, cardiovascular surgeon, performed the first non-surgical replacement of an aortic valve using the U. S. FDA-Approved Edwards Sapien Transcatheter Heart Valve Replacement technology at Phoebe Putney Memorial Hospital in Albany, Georgia.  Drs. Mohammed and Hoots replaced a patient’s aortic valve using a small incision in the leg rather than opening the chest and putting the patient on the heart-lung machine as is used in conventional open heart surgery.

“As a cardiovascular surgeon, it was disheartening to see patients I knew needed valve replacement, but were too high risk for traditional open heart valve surgery.  It’s very rewarding to bring new treatment options to those patients,” shared Anthony Hoots, MD. “I recall one of our initial TAVR patients was a dynamic 95-year-old woman who emphatically remarked she was very anxious to get back to riding a bike. To our delight, she reported at her post TAVR follow-up visit, she is indeed now able to enjoy her stationary bike in the comfort of her home.”

Dr. Mohammed echoed personal reward the new procedure brings. “Two things give me instant gratification in my field of interventional cardiology. Firstly, when we emergently open a “blocked artery” during a heart attack and save a life, and secondly, when I see an 80-plus-year-old man or woman sitting up in a chair the day following a TAVR procedure and able to walk in the hallways­­ -- clearly demonstrating we’ve given their quality of life back.”

“There is a huge paradigm shift in the management of severe aortic stenosis with the coming of TAVR. I am extremely delighted we are able to offer this procedure locally, in Albany, and have laid a foundation in the history of advanced structural heart disease management,” Mohammed continued.

Since the initial surgery, three additional patients have also successfully undergone the procedure, with more scheduled in the coming weeks.

Aortic Stenosis, a progressive, age related disease caused by calcium build up on the aortic valve creates a narrowing of the valve.  The condition causes the heart to work harder to pump blood through the smaller valve opening, which ultimately weakens the heart and leads to problems such as fainting, shortness of breath, fatigue, chest pain, heart failure and eventually death.

Aortic Stenosis is estimated to be prevalent in up to 7 percent of the population over the age of 65. All too often its symptoms are misunderstood by patients as normal signs of aging.  After the on-set of symptoms, patients with severe aortic stenosis have a survival rate as low as 50 percent at two years and 20 percent at five years without aortic valve replacement. Within the surrounding 35-county area an estimated 6,000 residents have aortic stenosis.

With this sobering statistic in mind, Phoebe recently introduced the Phoebe Heart Valve Clinic, comprised of a multi-disciplinary team including cardiologists,  Russell Jones, MD, Mark Cohen, MD, Khaja Mohammed, MD; cardiovascular surgeons,  Anthony Hoots, MD, Fran Herrbold, MD; valve clinic program coordinator, Pam Roland; and a team of advanced practitioners.  The clinic is designed to provide improved surveillance and follow-up care for patients in our service area who have been diagnosed with aortic stenosis.

The Phoebe Heart Valve Clinic team takes a collaborative approach to the evaluation of high-risk patients with valvular disease. All valve clinic patients are evaluated by both interventional cardiologists and cardiovascular surgeons collaboratively in the same clinic setting. During the clinic appointment, participating physicians review the patient’s medical history and results of recent tests and perform a physical evaluation. Specific diagnostic testing is performed before or during this diagnostic evaluation. Upon completion of the initial evaluation, a multi-disciplinary Valve Clinic team meets to review the results of these tests and prepare a recommended treatment plan.

Treatment for aortic stenosis depends on how far the disease has progressed. If the patient’s stenosis is mild, medication may be prescribed to regulate the heart, prevent blood clots and manage symptoms. However, medication is a palliative therapy, not an effective treatment for severe aortic stenosis. Current American College of Cardiology and American Heart Association guidelines indicate aortic valve replacement as effective treatment for severe aortic stenosis. With the addition of TAVR, there are now two options at Phoebe – surgical aortic valve replacement which is recommended for the majority of adult patients who do not have other serious medical conditions and transcatheter aortic valve replacement for high-risk or inoperable patients who will not qualify for surgical intervention due to advanced age and other comorbidities.

For TAVR to be recommended as an appropriate treatment pathway, the evaluation must confirm the following:

· The patient has severe aortic stenosis and is causing life-threatening symptoms

· Two cardiothoracic surgeons have determined that the patient is not a candidate for surgical aortic valve replacement or is a high risk for surgery and would be expected to benefit from TAVR

· The patient’s aortic valve and blood vessels are of appropriate size to accommodate the  TAVR procedure

· The technical aspects of the TAVR can be performed
 
The addition of the Heart Valve Clinic and TAVR procedure demonstrates Phoebe’s ongoing investment and commitment to ensure citizens of this region advanced cardiac care close to home. Phoebe is recognized throughout the state as a regional referral center for heart and vascular care providing comprehensive cardiac services and a continuum of care starting with prevention and diagnosis through complex surgeries and treatments - including both surgical and non-surgical procedures, angioplasty, coronary stenting, cardiac electrophysiology, bypass surgery and valve repair. Phoebe earned recognition from Healthgrades for five consecutive years and was ranked number one in Georgia for vascular surgery and overall excellence.