RRMC Performs First TAVR Procedures in Central Louisiana

Central Louisiana residents suffering from aortic stenosis now have a new treatment option available to them without having to leave the area.

Friday, Cardiologist Kanna V. Posina, M.D., performed Central Louisiana’s first Transcatheter Aortic Valve Replacement – TAVR – procedure in the cath lab at Rapides Regional Medical Center on 73-year-old Mansura resident Spencer DeCuir. Dr. Posina performed a second TAVR Friday afternoon.

Aortic stenosis is a narrowing of the aortic heart valve. It is estimated more than 2.5 million Americans over the age of 75 have aortic stenosis, with 250,000 new cases diagnosed annually.

Many patients have traditional open-heart surgery to replace the aortic valve. Some patients, though, are not candidates for open-heart surgery due to their medical condition.

For these patients, TAVR is a less-invasive option to replace the unhealthy aortic valve. Before now, patients in Central Louisiana requiring the procedure had to seek treatment elsewhere.

“This is another way for us to serve our community because people no longer have to seek this treatment away from home,” said Rapides Regional Medical Center Chief Nursing Officer Barbara Griffin, MSN, RN, NE-BC. “We are proud to be able to provide this higher level of cardiac care for our community.”

The TAVR procedure is done in a cath lab setting, and the new valve is inserted into the heart through a catheter inserted into the femoral artery in most cases.

While TAVR is performed in the cath lab and involves cath lab personnel, it also involves several other disciplines:

• Cardiovascular surgery. Heart surgeons T. Mack Granger, M.D., and Chance DeWitt, M.D., along with members of their surgical teams, were present in the room Friday.
• Depending on their condition, patients may be put fully asleep or given a local medication, as is the case in most cath lab procedures.
• Staff from the surgical team are on hand to assist as needed.

“The planning for this has taken more than a year and involves many disciplines,” said RRMC Director of Cardiovascular Service Line Chad Hinton, MBA, RT (N) (R). “We’ve had multi-disciplinary team meetings to discuss each eligible patient. The patients have to be vetted by two cardiovascular surgeons, cardiologists and team members.

“This has truly been a team effort to get to this point.”

In order for a facility to provide TAVR, several benchmarks have to be met:

• 50 surgical heart valve replacements performed in the prior year, with at least 10 on high-risk patients.
• Two cardiovascular surgeons on medical staff.
• At least 1,000 heart caths performed in the prior year.
• At least 400 Percutaneous Coronary Interventions (PCI) performed in the prior year, which is the placement of stents and balloons to open arteries.

Physicians also had to meet certain thresholds, including:

• Surgeons have to perform 25 surgical heart valve replacements in the prior year.
• Cardiologists have experience in structural heart disease with 100 corrective procedures performed in their career.

In addition, Rapides Regional Medical Center was required to have the following disciplines in place: imaging specialists (radiologic technologists), heart failure specialists, cardiac anesthesia, intensivists, nurses and social workers.

According to the American College of Cardiology, about 50,000 patients will have TAVR in 2018, with the number increasing to 100,000 by 2020.

“This was a historical moment for healthcare in Central Louisiana,” said RRMC Chief Executive Officer Jason Cobb, “and provides another example of how our medical staff, nurses and employees provide healthcare on a higher level.”