The Impact of a TAVR Program on a Vascular Surgery Practice

Abstract

<h3>Background</h3> Transcatheter aortic valve replacement (TAVR) is a less invasive alternative to surgical aortic valve repair offering treatment to candidates who may not tolerate a more robust surgical intervention. Five years ago, the cardiology group in our rural community initiated a TAVR program to further address the need for cardiac care. Operating under the heart team model our vascular surgery group has worked alongside interventional cardiologists and cardio-thoracic surgeons to ensure safe interventions. To date, over 300 patients within this community have undergone this procedure. <h3>Objective</h3> The purpose is to observe the role of the vascular surgeon in management of patients undergoing TAVR in a rural hospital setting. <h3>Methods</h3> Clinical data from a multi-specialty practice database was used for this study of 292 TAVR patients from 2016 through 2021. Patients were treated in a multidisciplinary approach with involvement of vascular surgeons, interventional cardiologists and cardio-thoracic surgeons. <h3>Results</h3> Of the 292 TAVR patients 275 (94.2%) were over the age of 65. Multiple patients required alternative access other than the standard transfemoral approach including 8 axillary, 2 trans-aortic, 1 each trans-apical and trans-septal. Vascular surgeons have been invaluable in management of intra-procedure and post-procedure complications. A dislodged aortic valve was deployed in the thoracic aorta and covered with aortic stent graft. For calcified access, vascular surgery has provided shock wave lithotripsy treatment to aid large sheath introduction. Other complications encountered include aortic dissection, acute limb ischemia, distal embolization and major access related hemorrhage. <h3>Conclusions</h3> Vascular surgery will continue to be an important partner in the care of TAVR patients in this medium sized rural health care setting. Vascular surgical assistance has aided in stabilization of concurrent disease, management of intraoperative complications and emergencies, and obtaining complex vascular access.