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Heart surgeries advance locally, nationally

When Dr. Nathan Boyer and the rest of PeaceHealth Southwest Medical Center’s heart team completed Clark County’s first transcatheter aortic valve replacement, or TAVR procedure, in 2016, he didn’t quite know where the technology was headed, but it felt promising.

The procedure uses a catheter to slip a valve into the body through blood vessels. TAVR can be used instead of open-heart surgery and is considered a less invasive way to replace a failing aortic valve.

At that time in 2016, and for the following three years, TAVR was only available for the highest risk patients, but in mid-August, the Federal Drug Administration approved the use of TAVR for patients at all risk levels — including patients ineligible for surgery, those at high or intermediate risk, and those at low risk.

The decision was made based on results from a trial published in the New England Journal of Medicine.

“The TAVR stuff has been super exciting,” Boyer said in a phone interview. “This technology in a short amount of time has really changed the field of how we approach valvular heart disease and the aortic valve in particular.”

Boyer is the Medical Director of the Cardiac Cath Lab at PeaceHealth and the TAVR Director at the Vancouver Clinic. He works on PeaceHealth’s heart team with Dr. Jane Luu, Dr. Terry Shih and Dr. Robert Dubose.

Boyer said an exciting part of TAVR is that you have to work together as a team, because the cardiologist and heart surgeons have to work side by side at the operating table, which wasn’t the case with open-heart surgery.

“This technology and this procedure in particular, really changed the dogma of how we used to approach cardiac problems historically. This requires a team effort,” he said.

Boyer said opening TAVR to more patients should have a positive impact of their outcomes. A general open-heart surgery lasts about four hours. Most TAVR surgeries are done in under an hour, Boyer said. A patient usually stays in the hospital for five to seven days after open-heart surgery. A patient usually leaves the day after TAVR, Boyer said. A patient usually needs six weeks of recovery time after open-heart surgery. But with TAVR a patient usually only needs about 10 days, Boyer said.

“This means getting back to normal and recovering from cardiac disease quicker than you would with open-heart surgery,” Boyer said.

Boyer said the TAVR team hasn’t seen any new patients who wouldn’t have previously been eligible for the surgery yet, but he does expect that to happen soon. He even mentioned some patients were reading scientific literature and hoping TAVR would become available to them.

Boyer said heart surgery technology is accelerating at a rapid pace. Boyer also completed Clark County’s first MitraClip procedure, another less invasive procedure that is used to treat mitral valve regurgitation for patients who shouldn’t have open-heart surgery. Right now that surgery is restricted like TAVR used to be, but Boyer thinks it could possibly be expanded in the future like TAVR just was.

“The field is moving so quickly it’s hard to keep up sometimes,” Boyer joked.


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