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  • Transcatheter Heart Valve Program

    UK HealthCare has pioneered the development of transcatheter heart valve interventions for more than 25 years. Since performing the first balloon aortic valvuloplasty in 1984, our physicians have expanded the range of catheter-based repair to mitral, pulmonic and prosthetic valve diseases.

    With the addition of transcatheter aortic valve replacement (TAVR) in 2012, the UK Gill Heart Institute continues to offer the most complete and most experienced transcatheter valve program in the region.

    Led by interventional cardiologist John Gurley, MD, UK’s heart valve team includes cardiologists, cardiac surgeons, advanced imaging specialists, cardiac anesthesiologists, nurse practitioners and care coordinators. The team performs TAVR and other minimally invasive heart valve procedures in a state-of-the-art hybrid operating suite at the new UK Albert B. Chandler Hospital.


  • Our program provides expert diagnosis and treatment by cardiologists and surgeons and encompasses a large outpatient and inpatient service that treats all forms of valvular heart disease, both before and after repair.

    Based on the most recent cardiovascular research, our experts employ the latest tools and techniques for diagnosis and repair of diseased heart valves, and we offer new and less-invasive therapies for valvular disease.

    Highlights of the valve program include:

    • Personalized care that incorporates the latest practice guidelines while respecting a patient’s individual needs and preferences.

    • A multidisciplinary heart valve team that brings together cardiologists, surgeons, imaging experts and other specialists.

    • The most modern and best-equipped hybrid operating facilities in the region.

    • The most experienced and most complete transcatheter valve program in the region.

    • A commitment to innovation in valvular heart disease – making the latest transcatheter techniques and minimally invasive surgical procedures available to our patients.

    • A commitment to excellence that leads to superior results and high patient satisfaction.

  • The Gill Heart Institute offers a comprehensive range of therapies to treat valvular heart disease, including:

    • Medical therapy
    • A full spectrum of catheter-based therapy for diseased or damaged heart valves
    • Surgical valve repair and replacement

    In some cases, valve replacements can be performed using a minimally invasive approach.

    Gill is one of a select number of sites in the United States to offer the new minimally invasive procedure called transcatheter aortic valve replacement (TAVR) for treating aortic stenosis. In collaboration with researchers at the Saha Cardiovascular Research Center, we continue to advance the field with new techniques for valve repair.

    TAVR procedure

    About transcatheter aortic valve replacement

    During conventional "open-chest" surgery to repair or replace a heart valve, the surgeon makes a large incision in the middle of the chest and cuts through the breastbone to access the heart. A heart-lung machine takes over the job of circulating blood throughout the body during the procedure, because the heart must be still and quiet while the surgeon performs heart valve surgery.

    Open-chest surgery to replace the aortic valve has been the standard treatment for severe, symptomatic aortic stenosis. However, the recovery can be difficult, and not every patient is eligible for open-chest surgery.

    For some patients with advanced age, frailty or other medical conditions, the risk of conventional heart surgery can be prohibitively high. These patients may benefit from transcatheter aortic valve replacement (TAVR), which allows Gill’s heart valve team to replace a diseased aortic heart valve without open-chest surgery.

    With TAVR, a balloon-expandable heart valve is inserted through a small incision in the groin. The valve is advanced through the arteries until it reaches the heart. If the arteries to the legs are obstructed, TAVR can still be performed through an incision between the ribs. TAVR patients are usually awake within an hour after the procedure.

    It is important to choose the right treatment option for patients with aortic stenosis. Valve replacement is not always necessary. Many patients can be helped with medication adjustments, coronary stents or other treatments. To help patients make the right decision, UK offers a team of specialists that can evaluate many factors including:

    • The benefits and risks of each type of treatment 
    • Your age and medical history
    • Your specific valve condition
    • Your lifestyle needs and goals

    Our heart valve team conducts a comprehensive evaluation before making any treatment recommendation. When valve replacement is necessary, the team decides whether surgery or TAVR is the better option. The team chooses TAVR when the risks of open surgery outweigh the benefits.

    For those patients who are candidates for TAVR, this therapy can provide relief from the debilitating symptoms associated with aortic valve stenosis.

     

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    • Turner, Vicky, APRN, Nursing Director/Valve Coordinator 

     

  • The following are just a few of the diagnostic tests that we may use to further understand and valvular heart disease. For more specific information, consult your cardiologist or other health care provider.

    Echocardiogram (also known as echo)

    A non-invasive test that uses sound waves to evaluate the heart’s chambers and valves. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart.

    Transesophageal echocardiogram (TEE)

    A test in which a small transducer is passed down the esophagus to provide a clearer image of heart structures.

    Cardiac catheterization (also called coronary angiogram)

    A test in which a small catheter (hollow tube) is guided through a vein or artery into the heart. Dye is given through the catheter, and moving X-ray pictures are made as the dye travels through the heart. This comprehensive test shows:

    • Narrowing in the arteries

    • Heart chamber size

    • Pumping ability of the heart

    • Ability of the valves to open and close

    • A measurement of the pressures within the heart chambers and arteries.

    Magnetic resonance imaging (MRI) of the heart

    A diagnostic procedure that uses a combination of large magnets, radio frequencies and a computer to produce detailed images of organs and structures within the body. MRI of the heart may be used to:

    • Evaluate the heart valves and major vessels

    • Detect coronary artery disease and the extent of damage it has caused

    • Evaluate congenital defects

    • Detect the presence of tumors or other abnormalities.

    • The cardiac MRI may be used prior to other cardiac procedures such as angioplasty or stenting of the coronary arteries and cardiac or vascular surgery.

    CT scan

    Computerized tomography generates a three-dimensional image, one slice at a time.

  • How heart valves work

    Human heart valves are remarkable structures. These tissue-paper-thin membranes attached to the heart wall constantly open and close to regulate blood flow (causing the sound of a heartbeat).

    This flexing of the tissue occurs day after day, year after year. In fact, the tissue withstands about 80 million beats a year, or as many as six billion beats in an average lifetime. Each beat is an amazing display of strength and flexibility.

    The heart has four valves:

    The mitral valve and tricuspid valve, which control blood flow from the atria to the ventricles

    The aortic valve and pulmonary valve, which control blood flow out of the ventricles 

    A  normal, healthy heart valve minimizes any obstruction and allows blood to flow smoothly and freely in one direction. It closes completely and quickly, not allowing any blood to flow back through the valve.

    Causes and effects of heart valve disease

    Heart valve disease occurs when one or more of the valves is damaged.

    Causes of heart valve disease:

    Degenerative valve disease

    This is a common cause of valvular heart disease. Most commonly affecting the mitral valve, it is a progressive process that represents slow degeneration from mitral valve prolapse (improper leaflet movement), a condition that affects about five percent of the general population. Over time, the attachments of the valve thin out or rupture and the leaflets become floppy and redundant. This leads to leakage through the valve.

    Calcification due to aging

    Calcification refers to the accumulation of calcium on the heart’s valves. The aortic valve is the most frequently affected. This buildup hardens and thickens the valve and can cause aortic stenosis, or narrowing of the aortic valve. As a result, the valve cannot open completely as the valve function is limited and blood flow is hindered. This blockage forces the heart to work harder causing limited physical capacities. Calcification comes with age as the calcium amasses in the heart over the course of a lifetime.

    Coronary artery disease

    Coronary artery disease affects the blood flow between the heart and its systems due to an accumulation of plaque in the arteries. This buildup causes hardening of the coronary arteries also known as atherosclerosis and restricts maximum blood flow to the heart muscle. Without an ample supply of oxygen-rich blood, the heart suffers. This may be result in chest pain or shortness of breath. If the arteries become completely blocked, the blood will not flow and will clot, leading to a heart attack. If a patient is exhibiting symptoms of coronary artery disease, a physician will run a series of tests including, but not limited to, an electrocardiogram or EKG/ECG, cardiac catheterization, blood work, and/or chest X-ray.

    Rheumatic heart

    Now uncommon, rheumatic fever is caused by an infection of the group A streptococcus bacteria and can detrimentally affect the heart and cardiovascular system, especially the leaflet tissue of the valves. Rheumatic fever is most common in children ages 5-15, but it can develop in adults. Rheumatic heart disease is more common in developing countries.

    Congenital abnormalities

    Generally, congenital heart defects affect the flow of blood through the cardiovascular system. Blood can flow in the wrong direction or in abnormal patterns, and it can even be blocked, partially or completely, depending on the type of heart defect present. Ranging from mild defects such as a malformed valve to the more severe such as an absent heart valve, congenital heart abnormalities require different treatments. In some cases, medicine can be used to treat the condition; in others, surgery may be necessary.

    Bacterial endocarditis

    Bacterial endocarditis is a bacterial infection that can affect the valves of the heart causing deformity and damage to the leaflets of the valve(s).

    Effects:

    Regurgitation

    Regurgitation occurs when blood flows back into the valve as the leaflets close or when blood leaks through the leaflets after they are closed. This condition causes the heart to work harder to pump the same amount of blood.

    Stenosis

    Stenosis is the narrowing of a valve opening that causes lower blood flow through the valve. This in turn increases the risk of blood clots and causes the heart to work harder.

    Resources

    UK's first TAVR patient gets health boost » 

  • Heart media library iconSee inside the heart (1mb Flash movie)

    Cardiovascular Media Library - See detailed animations of many procedures and surgeries. 

    UK Gill Heart Institute is the most comprehensive heart program in Kentucky, providing the most appropriate care. We unite the highest quality clinical care with leading-edge cardiovascular research to provide patients with advanced heart and circulatory health care.


Page last updated: 3/10/2014 2:58:28 PM