Berks County Medical Society Medical Record Fall 2019 - 14

m E d i C a l r E C o r d F E at u r E
Interventional Tactics in the Treatment of Severe Aortic Stenosis:
Major Contribution or Major Controversy?
continued from page 13

https://www.nm.org/conditions-andcare-areas/treatments/transcatheterheart-valve-therapies-for-aortic-valve

https://www.catholicmedicalcenter.
org/care-and-treatment/heart-care/
cardiology/interventional-cardiology/tavr

MOVING FORWARD

CONCLUSIONS

There is one more difference between transcatheter and surgical
aortic valve replacements worth noting: the medical professional
who performs the procedure. SAVR is typically conducted by
cardiothoracic surgeons in an operating room, and TAVR is most
commonly performed by structural cardiologists in a catheterization
lab. With the impending revision of the clinical guidelines that
dictate what type of patients are and are not eligible to receive TAVR,
it is anticipated by some that many of the severe aortic stenosis
cases will now be handled by structural cardiologists rather than
cardiothoracic surgeons. This has led to concerns over whether a shift
in the guidelines will lead to cardiothoracic surgeons-in-training not
having an adequate patient volume upon which they can perfect
their SAVR skills. As mentioned, there are certain instances when
SAVR is the preferred modality of treatment, and it will never be
completely obsolete.

TAVR should not be viewed as a replacement to SAVR; rather,
the innovation should be perceived as another path that healthcare
providers can take in the treatment of a complex disease, and another
procedural option patients can choose to best fit their individual
circumstances.

From a cardiology perspective, there are only about 30 fellowship
programs in the United States and Canada to train structural
cardiologists to preform TAVR ("Structural Heart Disease and
Congenital Interventional Fellowship Programs," n.d.). These
programs last one year, have limited training spots available, and are
only open to physicians who have previously undergone a three-year
internal medicine residency, three years of a cardiology fellowship,
and a one-to-three year interventional cardiology fellowship. While
one might think that such a drastic change in patient care may create
tension between the two groups of providers, it is important to note
that cardiothoracic surgeons and cardiologists comprise a team with
the same intention. The shared goal is to treat severe aortic stenosis
in order for patients to live happy, healthy lives unencumbered by
the symptoms of a partially occluded aortic valve.

14

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www.berkscms.org

Though TAVR is a cutting-edge procedure typically only offered
in major metropolitan areas, we are lucky in Berks County that
both Cardiology Associates of West Reading and Berks Cardiology
perform the procedure at Reading Hospital-Tower Health and
St. Joseph's Medical Center-Penn State Health. This insures that
all patients in Berks County and the surrounding area afflicted
with severe aortic stenosis, both low-risk and high-risk, are offered
the greatest variety of treatment options in managing their aortic
stenosis, the same options afforded to celebrities and rock stars like
Mick Jagger.

WORKS CITED
Rolling Stones. (2019, March 30). US Tour Postponement [Press
release]. Retrieved July 12, 2019, from https://www.rollingstones.
com/news/19/us-tour-postponement
Brito, Christopher. (2019, April 1). Mick Jagger tweets he's "feeling
much better" following reported heart valve surgery. Retrieved from
https://www.cbsnews.com/news/mick-jagger-surgery-rolling-stonesheart-valve-surgery/


https://www.catholicmedicalcenter.org/care-and-treatment/heart-care/cardiology/interventional-cardiology/tavr https://www.nm.org/conditions-and-care-areas/treatments/transcatheter-heart-valve-therapies-for-aortic-valve https://www.rollingstones.com/news/19/us-tour-postponement https://www.cbsnews.com/news/mick-jagger-surgery-rolling-stones-heart-valve-surgery/ http://www.berkscms.org

Berks County Medical Society Medical Record Fall 2019

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