Dharam Kumbhani, M.D. Answers Questions On: Heart Valve Replacement and Interventional Cardiology
How does transcatheter aortic valve replacement (TAVR) improve patient’s results?
Transcatheter aortic valve replacements are a big advance in how diseases of the aortic valve are treated. Traditionally, if someone had an aortic valve that was diseased, he or she had to have open-heart surgery. We are one of the few sites in the country that is able to take care of that valve without surgery. We go in through the side of the chest or the groin; while it’s still a procedure, we do it without cutting the patient’s chest open.
TAVR significantly reduces recovery time. The average length of stay is five days, and a lot of our patients go home in two or three days. We’ve had the program for over a year now, and we’ve had fantastic outcomes and very high patient satisfaction.
TAVR patients are traditionally older patients, and a lot of them have other health problems as well, which means they aren’t good candidates for open surgery. But they do very well with the TAVR procedure.
How does transradial angioplasty differ from traditional angioplasty?
Transradial angioplasty means we go in through a patient’s wrist rather than entering through the groin, which is traditionally how angioplasties have been done. It’s really a revolution – there is less bleeding, and the recovery time is almost instantaneous; patients have to wear a wristband for only about two hours after the procedure to stop the bleeding.
About 10 percent of angioplasties in the U.S. are done this way – it’s still a new procedure, and we’re very pleased to offer this cutting-edge option at UT Southwestern because patient satisfaction is extremely high. Patients are sitting up immediately after the procedure and using their laptops while they’re waiting for the wristband to come off.
The outcomes are the same for this method as they are for a groin approach. But the difference in the patient experience is very stark. When the procedure is done via the groin, the patient is on his back for six to eight hours after the procedure, and the bleeding risk is significantly higher.
Why is peripheral vascular disease hard to diagnose?
Peripheral vascular disease, also known as PVD, is extremely underdiagnosed as well as undertreated. A big part of that is due to atypical symptoms, especially in women.
People with PVD typically experience claudication, or pain in their calves when they walk; that’s the classic presentation. But a lot of times they also have vague symptoms – cold feet, foot pain, pain in the hips – which may end up being attributed to other issues, such as joint disease or back disease. So PVD needs to be on people’s radar more than it is right now.
Even in patients who are diagnosed with PVD, it’s being undertreated. In one of my recent studies, we found that only 62 percent of a very large group of patients – it was nearly 6,000 patients with PVD that we studied – were taking statins. And the guidelines say that 100 percent of these patients should be on statins. Such a low treatment percentage would never be acceptable if we were talking about coronary artery disease.
In my practice, I focus on medical and nonsurgical, stent-based approaches for the treatment of PVD. These procedures can help patients with leg and foot pain when they walk. They can also be limb-saving procedures for patients with ulcers in their feet that aren’t healing. A lot of people with undertreated PVD require amputations or bypass surgery, so these endovascular procedures are an important way to prevent that.