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U of U Doctors Perform First of its Kind in Utah Aortic Valve Surgery

Doctors at University Hospital have successfully performed an aortic valve replacement through the leg vein for the first time in Utah.

This version of a Transcatheter aortic valve replacement, known as a Transcaval TAVR, is a minimally-invasive procedure that has never been performed west of the Mississippi. Only five hospitals nationwide have done the surgery. The first was done in Detroit one year ago.

"Increasing the type of ultra minimally-invasive procedures for valve therapies helps to improve care for very high risk patients with excellent outcomes," said Amit Patel, M.D., associate professor of surgery.

He was one of the team of 15 on the two-hour procedure that took place September 10. Frederick Welt, M.D., professor of cardiology, and Anwar Tandar, M.D., associate professor of medicine, collaborated on the groundbreaking operation to make it a successful procedure.

"Through innovation and great collaboration we can provide the newest and safest procedures for our patients," Patel said.

Barbara Schreiber, 75, was a candidate because prior surgeries on her arteries in her abdomen and legs had left her arteries small and diseased. An immune disorder requiring steroid medication eliminated the traditional alternative of performing the procedure between her ribs.

So doctors chose to operate through the right leg vein on the Idaho Falls grandmother, inserting the new valve through there instead of an artery in the leg and then delicately crossed into the aorta to deliver the valve in the aortic valve. She received the same kind of FDA-approved valve that doctors had previously implanted in standard TAVR procedures.

"The major issue with TAVR is what we term access -- that is a vessel to place the sheath to allow delivery," said Welt, director of the Cardiac Catheterization Laboratory. "The devices are large and vascular complications are a risk. This is a novel way of delivering the device that may open up the possibility for many patients who had heretofore been excluded."

Before the surgery, Schreiber remembers feeling fatigued.

"I was just kind of running on empty doing what I had to do," she said, speaking from her hospital room just minutes before she was about to return home. "I didn't have extra (energy)."

Schreiber's hope is that - thanks to the surgery - she'll have more pep and be able to get more accomplished. If she wants to mow the lawn, she will.

The TAVR procedure replaces a valve without having to remove the one that is damaged. The new valve is collapsible and inserted into the body through a catheter. It then takes over from the old valve and helps regulate blood flow. The TAVR procedure typically requires that a patient stay in the hospital about three to five days, a significantly shorter amount of time than for some other heart surgeries.

Like Schreiber, many candidates for the procedure are in their 70s or 80s with other medical issues. New research shows that people with TAVR survive at least 2.5 years longer than those with standard of care. The standard TAVR procedure has been successfully done at the University of Utah for more than two years.

Schreiber's advice to anyone considering the new surgery is to "go for it."

"This was absolutely amazing what they could do, what they did with this procedure," said the Idaho Falls grandmother of three, who said she was looking forward to sleeping in her own bed that night. "It worked and I'm fine."