On the second floor of Providence Health Center, Dr. Brian Barnett, a cardiologist, spoke of a new $6 million setup at the hospital, where doctors now can use a narrow tube inserted through the groin to replace diseased heart valves while patients watch.
Listening in, 73-year-old Thomas Davis, from Goldthwaite, rested on his cane and absorbed the presentation, which included a video and a replica heart.
He had heard it all before, and it changed his life.
Davis has been traveling to Waco for years, from homes in Lake Dallas, Goldthwaite, even Colorado, visiting his longtime heart doctor, Charles A. Shoultz, now retired. Davis suffered from various heart-related maladies, and Central Texas Cardiology kept tabs on a leaky heart valve.
“It finally got to the point I had to have something done,” he said. “I was always short of breath, panting upon exertion. I thought I needed surgery.”
He became one of the first, if not the first, patient to undergo a procedure at Providence Health Center called transcatheter aortic valve replacement, or TAVR, which is minimally invasive and does not require a surgical team to crack open a patient’s chest to replace a diseased valve.
The process has been around for about a decade and is available at Baylor Scott & White Medical Center Temple. But the Heart Hospital at Providence, part of Ascension Texas, introduced it locally in October, said Dr. Barnett, 38, who has an undergraduate degree in pharmacy at the University of Texas, attended medical school at Texas A&M University, and received specialized training in the TAVR process before performing procedures in Temple.
Barnett now serves as TAVR medical director at Providence.
“My recovery time? About a week and a half, maybe two weeks,” said Davis, who followed his physician to the spotlight on Wednesday, when Providence hosted an hourlong news conference to unveil its TAVR protocol.
“I had no shortness of breath,” Davis said. “I could do anything my bad legs would let me do. The doctors in Waco have been great.”
TAVR is the centerpiece of Providence’s new Structural Heart Program, which features a room recently remodeled to accommodate TAVR procedures, upgrades to the catheterization lab, where heart rhythm abnormalities are diagnosed, and plans to add additional procedures. Barnett said the expertise and technologies available in the Structural Heart Program will assist doctors in treating heart-related issues that could produce strokes, as well as congenital holes in the heart found in a high percentage of infants.
TAVR reduces recovery time and the length of hospital stays, according to a Providence press release. There is no need to stop the heart during the procedure, it inflicts significantly less pain than open-heart surgery and represents a “life-saving option for high-risk patients,” the press release states.
Barnett said TAVR is not classified as emergency surgery, and patients deemed candidates for the procedure typically have it done within 10 days to two weeks. They undergo extensive testing during that time, and arrive to discover Barnett will be joined by a 12- to 15-person team in the TAVR room. The team includes at least one additional cardiologist, usually two, as well as imaging technicians, nurses and heart specialists.
The procedure itself involves inserting a catheter through an incision in the groin area and guiding it to the heart through the circulatory system. The replacement valves are made from bovine tissue, Barnett said.
Patients typically remain awake and only lightly medicated. The procedure lasts 28 to 30 minutes, and it is not unusual for patients to be up and walking within six hours. Many leave the next day, Barnett said.
TAVR is approved by the Food and Drug Administration for symptomatic aortic stenosis patients who are considered an intermediate or high risk for standard valve replacement surgery, according to the American Heart Association website.
“This minimally invasive surgical procedure repairs the valve without removing the old, damaged valve,” the website states. “Instead, it wedges a replacement valve into the aortic valve’s place. … Once the new valve is expanded, it pushes the old valve leaflets out of the way and the tissue in the replacement valve takes over the job of regulating blood flow.”
A damaged valve can reduce vital blood flow to organs such as the brain and kidneys, Barnett said. Symptoms may include weakness, fatigue and fainting.
Providence Health Center representatives said they do not discuss specific costs of the procedure. But Barnett and Billy Fowler, who manages the Providence catheterization lab, hinted that the number of people involved in carrying out TAVR procedures mean it is not necessarily a low-cost alternative to more traditional valve-replacement approaches. A 2015 New York Times article states the replacement valves required in TAVR cost about $30,000, which is four or five times more than those used in conventional open-heart valve-replacement surgery.
“The valves are not cheap,” Fowler said.