Horizon, Host: Ted Simons

February 20, 2013


Host: Ted Simons

The Latest Procedure: TAVR


  • Dr. David Rizik will discuss Transcatheter Aortic Valve Replacement, a non-surgical approach to treating aortic valve stenosis, a narrowing of the aortic valve.
Guests:
  • Dr. David Rizik
Category: Medical/Health   |   Keywords: the, latest, procedure, latest procedure, ,

View Transcript
Ted Simons: After the 1983 heart operation broadcast channel 88 continued to feature medical procedures with special programs on hip and knee replacement surgery. That tradition continues with a new medical series titled the latest procedure co-produced by Kaet with Chris Wooley of VAS communications and Wayne Dickmann of even keel productions. It showcases a nonsurgical procedure to fix narrowing of the aortic heart valve. Dr. Rizik is medical director for Scottsdale health care. Thanks for being here. 30 years ago that was quite an event.
Dr. Rizik: I'm humbled to be sharing the studio with the doctor. You're talking about one of the pioneers of the last 30 years. My first live case I did as part of his meeting. He gave me a chance to do a live case when I was right out of training and two things happened that day. First I got bit by the bug, that teaching education bug that he instills in everyone, but I got to do that live case with Denton Cooley, a world famous heart surgeon, standing over me. I got to say I think I was sweating a little bit that day.
Ted Simons: you're not sweating during this production. Let's get to T. trance catheter aortic valve catheter. What is this?
Dr. Rizik: Historically a blocking of the valve that leads out of the heart, think of the aortic valve as a one-way door out of the heart. Traditional way, the time honored way of treating this is with open heart surgery. Open heart surgery not dissimilar to what you just saw, but a lot of patients who are elderly, frail, have a number of other comorbid diagnoses, may not ab Anderson indicate for such an invasive procedure. Now we have a trance catheter aortic valve replacement which is geared toward elderly, frail patients. Patients who may not be candidates for surgical valve replacement. They too can have their valve replaced. It's a minimally invasive way of accomplishing the same thing.
Ted Simons: take us through this, the idea that a new valve was carried inside a catheter? A small incision is made and we go from there?
Dr. Rizik: That's right. It's mounted on a balloon similar to stents for coronary arteries although it's larger in profile. It's mounted on a balloon. We go in much the same way as we perform angioplasty through a minimally invasive incision in the femoral artery in the grown or thigh area, thin this is passed up to the heart and is implanted. The balloon is inflated, deflated, retreated and the valve is in place.
Ted Simons: No saw, no scalpel.
Dr. Rizik: no saw, minimal scalpel.
Ted Simons: no chest spreaders, though.
Dr. Rizik: no chest spreaders.
Ted Simons: Where did this technology come from?
Dr. Rizik: About ten years ago, some very forward thinking interventional cardiologists, scientists, researchers began to develop the concept of a catheter based valve replacement. At that time, not dissimilar to what Dr. Diethrich just said, there were a lot of naysayers. You're cowboys, showoffs. This will never work. Somewhere around five or six years ago, they began these researchers to show proof of concept. Now this is approved in over 50 countries around the world including the United States.
Ted Simons: What kind of recovery time are we talking about now as opposed to recovery time ten, 10, 30 years ago?
Dr. Rizik: When you think about traditional surgical valve replacement you're talking from five to ten days in the hospital. We generally send these patients home within 48, maybe 72 hours of the procedure. You're talking about okay to Jen aryans. These are not young, healthy patients, necessarily, these are older patients to. Get them home in 48 or 72 hours is an amazing achievement.
Ted Simons: the heart valve, what is it made of?
Dr. Rizik: It's a stainless steel cage now a cobalt chromium cage so it's attached to this stainless steel or cobalt chromium framework and it's crimped on a balloon and then taken up to the old valve, the diseased valve, and implanted there.
Ted Simons: What follow-up is required?
Dr. Rizik: Generally we see them the next morning and for several days after, but then they go home and routine follow-up in the office, we usually see patients a week or two later. We get an ultrasound of their heart a sound wave test to make sure it's functioning, but we have had tremendous success with this new technology.
Ted Simons: as far as the program is concerned, I asked Dr. Diethrich, he was prepared, he was, obviously, everyone seemed well prepared foregoing on live television for the first time with open heart surgery, but knowing that you're on television, knowing you're being taped and you have a relatively complicated procedure here, do you get nervous?
Dr. Rizik: Not at all. One of the keys is teamwork. We have a team. While I was flattered to be the voice of this procedure, we do have a team of multiple doctors who work on this. But we are used to having the camera on us. We do a lot of teaching cases. And we do a lot of live telecasts mostly for physicians. This was really just another day at work with cameras in the room. Our first focus we concentrate mainly on the patient, but we have cameras and we're used to talking and teaching during our cases, so it want that much different.
Ted Simons: education the primary focus 30 years ago. Still today?
Dr. Rizik: Absolutely. The key to what we do is education. None of us learned these procedures by reading them out of a book. Somewhere along the line we had to see these cases being performed live. Dr. Diethrich talked about educating the public. I believe he's right on the money with that. This really demystify was we do and educate the public. It's a perfect forum for education.
Ted Simons: with all this in mind, we just saw what happened 30 years ago, we're going to see what happens today. Where does heart surgery, where -- treating conditions of the heart, where do we go from here?
Dr. Rizik: There are no limits. If you think that in ten years we took a concept, drawings, all the way through FDA approval and approval through agencies all over the world, over 50 countries, to think in ten years that's what we have achieved and we're learning this and advancing the technology on the oldest, sickest, most frail patients, there's no limit to what we can do in heart and vascular medicine.
Ted Simons: no limit apparently for the technology as well.
Dr. Rizik: absolutely true.
Ted Simons: you think something big will happen soon or is this something that develops over time?
Dr. Rizik: I think that we see these things develop over time. Ten years ago is an awfully short period of time to have developed this, but I think we'll see more and more cardiovascular miracles occurring every year. It's really a fantastic time to be in heart and vascular medicine.
Ted Simons: what do you want viewers to take from the broadcast of the latest procedure?
Dr. Rizik: I think the main thing is that we are pushing the envelope in terms of our ability to treat sick patients with heart and vascular medicine. I think the important thing is that they see their physicians if they are not feeling right, if they are having symptoms. We're treat ago lot more of these untreatable diagnosis today than a decade ago.
Ted Simons: doctor, thank you for joining us. We appreciate it.
Dr. Rizik: great to be here.
Ted Simons: And that is it for now. I'm Ted Simons. Thank you so much for joining us. You have a great evening.


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