The South Carolina Heart Valve Center (HVC) at MUSC is the first center in South Carolina and among the first in the nation to perform transcatheter aortic-valve replacement (TAVR), a cutting-edge procedure for implanting a heart valve that does not require open heart surgery. Although surgical aortic valve replacement (AVR) remains the gold standard for treatment of severe aortic stenosis, TAVR makes treatment available to patients in whom surgery is contraindicated because of advanced age, frailty, or poor lung function (among other reasons) who would otherwise have gone untreated. According to John S. Ikonomidis, M.D., PhD, Director of Cardiothoracic Surgery at MUSC, “It’s difficult, if you look across the medical community, to find a single procedure that modifies mortality in the way this procedure has in medically managed patients.”

Both TAVR and aortic valve replacement are treatments for severe aortic stenosis, or the obstruction of blood flow across the aortic valve because of calcific plaque. An estimated 2% to 9% of the elderly have aortic stenosis. Although aortic stenosis can gradually develop over years without symptoms, once symptomatic it takes a high toll in terms of mortality, higher even than a variety of cancers, including lung cancer. Patients with severe aortic stenosis have a survival of only 50% at 2 years and 20% at 5 years if the condition is left untreated.

Until TAVR, those deemed unsuitable for surgical AVR had to face such grim statistics knowing that no treatments outside of medical management were open to them. It is estimated that 43% to 74% of patients with severe aortic stenosis never undergo surgery, either by choice or because it is contraindicated. Preliminary data from the PARTNER trial (on which FDA approval was based; NCT00530894) showed a 20% to 25% reduction in mortality at 2 years with TAVR versus medical management alone.¹ Patients also report an improved quality of life after successful TAVR.

Instead of implanting a replacement heart valve during open heart surgery, TAVR involves collapsing a bovine heart valve mounted onto a stainless steel stent (the Edwards SAPIEN® valve, Edwards Life Sciences, Irving, CA [pictured here]) tightly over a balloon, inserting it via a catheter into the ileofemoral artery and advancing it to the aortic valve. The procedure is performed twice: on the first pass, the balloon is expanded to open up the stenosis and on the second pass the Edward SAPIEN valve is deployed.

The interdisciplinary HVC at MUSC was specifically created to leverage these new types of valve technologies that dramatically alter a patient’s treatment options. The multidisciplinary capabilities of the Heart Valve Center, including its depth of expertise both in interventional cardiology and cardiac surgery as well as cardiac imaging and anesthesia, were key to its being approved by Edwards, the manufacturer of the Edwards SAPIEN® heart valve, to implant the device. These devices can only be implanted once both an interventional cardiologist and a cardiac surgeon have assessed the patient (in part by preprocedural imaging) and have agreed that he or she has a greater than 50% chance of dying or experiencing long-term complications from surgical aortic valve repair.

Possible complications of TAVR include stroke (some plaque may be dislodged as the valve is advanced through the vessel) and vascular damage, both of which can be life-threatening. Careful patient screening (ie, to ensure that the patient’s vessels are of sufficient size to allow the device to be implanted via a catheter) should help to minimize those risks.     

TAVR is most appropriate in patients with severe aortic stenosis who are not suitable candidates for surgery and who would stand to gain considerable quality of life as a result of the procedure. It offers a treatment option, increased survival, and increased quality of life to a large pool of patients who would otherwise go untreated. For a referral to the TAVR program, contact MEDULINE at 1-800-922-5250 or 843-792-2200 and ask to be connected to Daniel H. Steinberg, M.D., the primary interventional cardiologist at the HVC involved in the TAVR program, or Suzanne Richardson, RN, the TAVR program coordinator.

¹  Leon MB, Smith Cr, Mack M, et al; for the PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363:1597-1607.

The Society of Hospital Medicine (SHM), the leading organization representing hospitalists, recently inducted Patrick Cawley, M.D, MUSC's Executive Medical Director as a Master in Hospital Medicine.  

The Master in Hospital Medicine designation is the highest honor awarded by SHM and is by nomination only, based on the individual’s contribution to the hospital medicine specialty and his or her commitment to excellence in fields such as clinical care, healthcare initiatives, research, writing and publication, and administrative positions.

Please join Dr. Lee Saunders from the Medical University of South Carolina (MUSC) on Tuesday, May 29, 2012 from 3:00-4:00 pm EST for the presentation of the webcast, “Health Care Access after Spinal Cord Injury.” Dr. Saunders holds the rank of Research Assistant Professor in the College of Health Professions at the Medical University of South Carolina, and is part of the Longevity after Injury Research Team (http://www.musc.edu/chp/sciorg).  She is the Co-Director on the “Rehabilitation Research and Training Center on Secondary Conditions in Individuals with SCI” (RRTC grant) and Co-Investigator on the “Center on Health Outcomes Research and Capacity Building for Underserved Populations with SCI and TBI (DRRP grant).”

Date: May 29 ,2012

Time:  3:00 PM EST

Log in a few minutes before 3pm on May 29, 2012 to participate at:  http://www.ccitonline.org/Accordent/musc/052912

The purpose of the upcoming webcast presentation is to:

1.       Describe health care access after spinal cord injury.

2.       Assess secondary health conditions as a function of access to health care after spinal cord injury.

3.       Identify the extent to which black persons with spinal cord injury have equal access to health care compared to black persons in the general population.

An article appearing in the April 4, 2012 issue of the Journal of the American Medical Association, coauthored by Dr. Etta D. Pisano, M.D., Professor of Radiology and Dean of the College of Medicine at MUSC, reported better detection rates for early, node-negative, invasive breast cancer in women with dense breast tissue and at least one other risk factor when annual mammography was supplemented with ultrasound or magnetic resonance imaging (MRI). This is the first study to show that the increased detection of early invasive breast cancer seen with ultrasound persists after the initial screen, providing evidence of its usefulness as a supplemental screen to annual mammography.

Although detection rates were highest with MRI, it is expensive and not tolerated by some patients, making ultrasound the better choice in patients with intermediate risk or in high-risk patients who do not tolerate MRI. Both ultrasound and MRI screening are associated with increased false positives, potentially leading to unnecessary biopsies, but the rate of false positives was lower in women with a personal history of breast cancer, and it decreased with regular annual screening.

It is important for every woman to speak with her physician about which screening process is most appropriate given her own medical history and risk profile.

Peter Kalivas, PhD, professor and co-chair of the Department of Neurosciences, received the South Carolina Governor’s Award for Excellence in Scientific Research while attending the S.C. Academy of Science Annual Meeting on April 14. Kalivas was recognized for his scientific discoveries regarding drug addiction and serving as an academic leader and department chair in the Medical University of South Carolina (MUSC) College of Medicine for more than a decade. Kalivas’ work contributed to a significant rise in national stature as a leading medical research institution.

Peter is highly deserving of this award, and we are fortunate to have a scientist of his caliber focused on translating basic science discoveries into clinical interventions for drug addiction, which is a significant problem for South Carolina and the nation as a whole,” said MUSC College of Medicine Dean Etta Pisano, M.D. “In large part due to Dr. Kalivas’ leadership during the last decade, South Carolina now harbors one of the top-tier addiction and neuroscience research organizations in the country.”

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MUSC Children's Hospital was recently designated a Level 1 Pediatric Trauma Center. We are the only hospital in the state to have received this designation.  

The April/May issue of Progress Notes, a bimonthly publication highlighting clinical and research innovations at MUSC, is now available online.

In the April/May issue, read about:

• The drug shortage crisis and MUSC’s response
• The telescopic lens, a new treatment for end-stage macular degeneration offered at Storm Eye Institute Video
• Slide tracheoplasty, an innovative treatment for children with congenital tracheal stenosis Video
• The recommended management of pediatric obesity CME
• Cancer drug discovery at MUSC

Write Kimberly McGhee, Managing Editor, with questions, comments or story ideas at mcgheek@musc.edu