Transcatheter AorticValve Replacement (TAVR) Oklahoma Heart Institute ...

Oklahoma Heart Institute 1120 South Utica Avenue

Tulsa, OK 74104

Oklahoma Heart Institute Physicians Office ? Utica 1265 South Utica Avenue

Suite 300 Tulsa, OK 74104

Oklahoma Heart Institute Physicians Office ? SouthPointe

9228 South Mingo Road Suite 200

Tulsa, OK 74133

918.592.0999

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150--1155

Valvular Heart Disease:

Transcatheter AorticValve Replacement (TAVR)

Transcatheter Mitral Valve Repair (TMVR)



THE HEART

THE HEART

How Does Your HHowedaorestyWouor rheka?rt

woTrhke?heart is designed to pump Thbeloheoadrttihs rdoesuignhedyotouprubmopdbyl.ood thrTohugehryigohurt bsoiddye. oTfheyoriughrthseidaertof ylguoenplnuug.urnshm,Tgewhspaeh,rstelweprbefuhltomteshoirpededsebbtlotohlhfooertodhodbepultihhogcerkohoasdrututghpprheeio-tchxkeysceuivpesotxhiysgbelono.Td hanedlepuftmspisdiet ionfto thethreesthoefayroturrebcoediyv.es this blood

and pumps it into the rest of

your body.

Chambers and Valves

CEhacamh btiemrseaynodurVhaelvaerst beats, Eitapchutmimpesyboluorohdeatrht broeautsghit pvuamlvpessbbloyodcothnrotruagchttihnegseitvsalves by cvcoahlnvatermascbotipenergnsi.itnsTcohhneaesmdebireveracstl.ivToenhseasolelopweniinngobnloeodditroefclotwionforawllaordw. iInngbeb-lood ttwoefelnowbeaftos,rwthearhdea. rItn'sbcheatmwbeeerns qbueiacktsly, rtehleaxh, eanadrti'tss cvhalavmesbcelorsse, pqrueivcekntliyngrebllaoxod, afrnodmiftlsowvainlgvebsackwclaords.e, preventing blood from

flowing backward.

This is the picture used in both the heart valve clinic brochure and TAVR clinic brochure

1

Picture of Team

Valve & Structural Heart Center Team after completing the 100th TAVR procedure.

NOTES _________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________

10

HistoryToAfHTVaiAstVRtRo//TrTyMMoVVfR R

Oklahoma HHHaetieasaOtrortkrtlIynaIosnhftsoTittmAiutVatueRte/TMVR

at PerfoPremrefdo5rfOi/mr2sk/et20lMTda1AA2FhVYioRr2smi,tn2TaT0Au1HVl2sRaeainrtTuIlnsastitute

First Ftriarsnts1aT1pNr/i1acO3anV/ls2ETa0PAM1peVr2iBfcoREramRilneT1dTA35fui,/Vr2ls2/sRt2a00T11Ai2n2VRTuinlsTaulsa

First FtriarsntsaT6or/r4at/in2cJs0TUFa1AiN3orVsrEtRttri4cai,nn2Ts1aT0A1pu1/iV1cl33saRa/l2T0iA1nV2 RTuinlsTaulsa FirstFviarlsvte-VinNa-lvOvaeVlv-EFeIMnirT-sBAtVtEVarRaRlnv2seian66o,/TrO4tA2/i2cK0V0T11AR33ViRninOTKulsa

Firs1t1C/2o6/m2F0imr1s3tevraclviae-li1n1C-/v2oa6lr/v2ee0V1T3AaVlvRein OK First commercial CorTeVAaVlvReiTnAOVKR in OK

2FF/E2ir1Bs/tR1cU4omAmRYerc2ia1l,2C/22o01r/e11V44alve TAVR in OK

First TAVR withoFuitFrgisresttnATTeAArnaVVelRRaswtnhiwethsetiotshuhietasogieaiunnteinrOaGOlKaeKnnese2t/hr2ea1sli/a1i4n OK 2/21/14

First left subcFlaEvBiaFRniUrsTAt AlReVfYtRs2u1binc,l2aOv0iKa1n4TAVR in OK

First Le3f/t25S/u1b4 clavian3/T25A/1V4R in OK

MFAiRrsCtHTr2a5n,sC2a0v1a4l TAVR in OK

First TrFairnsstC9STa/Er2vPa3aTn/lE1sTM4CAaBVvEaRRl2Ti3n9A,/2OV230R/K114i4n OK

First commercial MitraClip in OK

First cFoimrsmt eCrocmialmMeritcriaaCl Mlip1it1ir/n1a8CO/1li4Kp in OK

NOVEMBER 18, 2014

11/18/14 9

HEHAERATRVTAVLVAELVS ES

HEART VALVES ThseahnsedtihAnrThgeoaehbrsllteeotihacofrAdVleeteotaosllrtvaehtneaeidflcreiettsVsct.ooaInftlttrvchooeelsnbbtorldooyols.dbflloowodfrfolomwthferolemfttvheentlreifctle to the aorta, ventricle to the aorta, sending blood to the rest of the body.

ThnaahsryethaPrThreutaeehlsrmlyeetThs,haoeashfnrPnseleedetnaihuetAndrrsgelil.oyenembrIgaltlVteoifcacooblafoedlVllnoentvttasootsaerl.dtvoahIrneltetsdyocrbiettosVlhctoneoooatnflrdtultrohovnflellgsseobsbwboltdolooyfor.dopoifdmclokfwltohufepwrormoifxgrtyhohegtmevleneft.tnhvtereinrctilrgeichlteottoththeepauolrmta,o-

ventricle to the pulmonary artery, sending blood to the

ThveahnsettrhiTcrlThuelraeenhis.cgleuetsThnThasaahhtfrTpsrloyeeeetihreadtPTprsrieutrlieVceaecilrcmnaklyuaued,faosllussfvenpielptpentaeidtscdrsoi.io.yVndxIIngtVtaytcbrlVacgovollooneevlaotsnnerdlo.trrriiciulgemhtottothethpeulrmigoh- t

The MatirtiruahmalsVtthoareltevhleeearfliegths tanvdeint ctornictrloels. blood flow from the right atrium to the right

has twTo hleeavfelMenttrsiicatlenr.daitlcVonatrlovlseblood flow between the left atrium and left ven-

tricle.has tTwhoe MleaitfrlaeltsV.aIltvecontrols blood flow between the left

.

atriuhmas atwnodlelaeffltetvs eanndtriticcolent.rols blood flow between the left atrium and left ven-

tricle.

.

TTwwoo CCToowmomCmmoomonmnHoHneaeHraetarVrttaVVlavalevlevPPerrooPbbrlleeommbsslems

Stenosis:

SWchWplboeilitghsermhehtteteheepnnrncldolyheyoeylootofo(seepaluuelcSWpbieeyrrwtlisstnser)hevtvttota:eheneeobaaxrpnlorlredoylyveoseyvclboiefon(alefseupauau:c(neirbnwttslana))dveeaa,robaw-xrcraolreuoyvragcafbpoweafueuxpauwno,isstsylra)fdgeeo,sar-refcabonuooaangaflpdwteefnelp)o,csmdtrpd,fgiioaocuresacbndsenomaldgleseolbi(cemdt.kseiinl,ocuuesesosemgclmshti(enh.ksnicnusoegooacehthtslmhiitcgkcaioa-chhsmesoca-h-o-

(such as a birth defect) or build-up of calcium

RRWeehggeunuryrgogiutRWliaortwethvgiaesaounlbtnrvlyigoe:oooiutddarnottvoie:aosllnvenae:kodtboaefcsuknlwloyat rfcdulsloltyshecrolaousngedhatanhdle-al-

Wlohwesnbylooouvdratlvoeallevaekdboaeckswnaortdfsutlhlryoculgohsethe avnadlvaellows blood to leak backwards

through the valve

2

AORTIC STENOSIS

What is Severe Aortic Stenosis?

AAOORRTTIICCSSTTEENNOOSSIISS Aortic stenosis is often caused by the build-up of calcium (mineral deposits) on the aortic valve's leaflets (flaps of tissue W AoW AtthhhrotaarihrctottaisciutostegsipSnstheeoeSnsnvtoeihessvarieiesnesraidoeAsofotAocrefrltntooeitrcicnsctaeicvuScaastuteSolesdvtneeredbone)ysbog.ityssuTh?itelshha?beitsuebibuldtiuhl-duie-lpudopo-nfuocepfa-clwocailfauccimyuamf(llmco(imiwuniemnroeafrloadbnleldpoteohopseoditssi)tso)non thtleheaeaoafrloteirctisvcaivlmvalepv'esa'liseralsefaltefhtlseet(sfal(aofplrastpioscfotvfisatsilsuvseuete'hstahatabotpiolepinteynantadoncdfluoclsloelsyteootropergeeungluaatleanttedhtechoelonoesn-ee.wawAyasfylaoflwroewosfoubflltbo,lootdhotdehtrnhoruaogruhrgohthwteheaedoarotvircatilvcvavelvaleav)le.l)oT. whTishiblseubsiulsdil-odu-pxuypofgocefanclca-rilucicimuhmobnolntohteohde lealteofalefftllseotiswmimpfapriroasimrtshtethhaeoearotliructinvcgavlsvaletv'oes'atshbaiebliitblyitrtyaotiofnuflaulylnloydpoerpneesantnadondcfltochlsoees.eAb. osAdas yrae,rsweusluht,littc,hthehe naannanaamerddnnarxorddreaterwxyorresteeewtxrcsedtometrmafedvouemetafhvlsfetevfaahealeftbevtiasaoegitblygdiulaogoymeuldul.wewoyepEs.w.hwvtElEisoeehcvnslvmhieesctenusmhosstnauxmaloltlayyiyuxalgkl,ycyayeetganl,hcuel-taesynshruee,i-hecsrvtesheihhcayeeshbrmeratyl'ebrompshtlot'sompoesdhotmamuotdorosmsucttrlfos'sltislecknolfsliemlweekowsseswufeewsrsvasofeeekorcmvaorefleekmnetrebh,sesnhteirh,snowehleicrunaotrelnncertuartgaehnnessskgaeisantesssoonisgnntfotdotg,hbhftertehbehberaperetabahap-ritanah-in tietininetcn'str'resiasrkissioknfoghfethaheraterftapfialuitlriueeranentad'nsddrediasetkhat.ho.f heart failure and death. SpaveeSpaStdeovrveereipeeoaevrlvrgapeeeaewerltgwaeemroeoiehwatfroeoohthtaifrnwcioftonteitowscfer,telateoysheintsenlceyaioacnselrsaskiofasicvts.rsfkoesieris.ofsnfrrimaatooshgmsvateheeivstrihspeyoiripessfyreoptoasrwpreiboorvlliboueeeomlsuerywpmsyderhpioasderboeriowlesbref.iimwleteohiem.utiWhnl.sisWanipitnchairtnokohuobtfurlttroeetmmraetma.ttWmehnieitsnt, hthp,aorhluofalotbffloetfhmtehe

3

Cardiovascular Surgeon The physician who specializes in heart surgery, including the repair or replacement of heart valves.

Paul Kempe, MD Dr. Kempe received his undergraduate degree in Chemistry at Abilene Christian University. He completed his medical degree at the University of Texas Southwestern Medical School in Dallas. His Internship and Residency were completed at Richland Memorial Hospital in Columbia, South Carolina. Dr. Kempe is board certified by the American Board of Thoracic Surgery.

AdAddDd rD. rC.hCehnegnagnadnd hishibsiobio

DPoMfrro.TicPfhehhosaisrlaleiiocplniscPahlShaouisrlrlggbiapeenoesinn,zsaMa,tiACoDmnar,sedForiiofAcvwaCanhsCicCcu,ohlFlalherAegTCeihsoSoafrmaCcaeircmdSbiouelrrogCpwsigeinuhtyioCpwsetct,aihunlhtGiSnuettabohgsedGniiecooenbgeirAcieetogoohetirnnAyageon2nwinfn0aSaonn0enowraeab1ncne.aeidbentdy Endovascular Surgery and American College of Surgeons. Dr. Michael Phillips is board certified in Surgery, and Cardiovascular and Thoracic Surgery.

Valve Coordinator The nurse who acts as a resource to patients and their families throughout the entire treatment process.

Georgianne C. Tokarchik, APRN-CNS Georgianne C. Tokarchik, APRN-CNS, received her Master's degree from the University of Oklahoma as an Acute Care Clinical Nurse Specialist after completing a Bachelor of Science degree in Nursing from The University of Tulsa. She began her career as a Registered Nurse with a primary focus in cardiology. Georgianne holds a national certification from the American Association of Critical Care Nursing as an Adult Health Clinical Nurse Specialist.

Anesthesiologist The anesthesiologist is trained to provide sedation during surgical procedures.

Critical Care Physicians and Nurses The critical care or intensive care unit in a hospital is a specialized area where you are closely monitored and treated following cardiovascular surgery. The critical care team manages your care during this time.

8

MEET THE TEAM

If you plan to undergo TAVR or TMVR, you will be cared for by the Oklahoma Heart Institute team of cardiac medical specialists who are committed to ensuring your safety and comfort before, during and after your procedure. Below you will find information describing different health care professionals you may meet during the course of your care.

Primary Care Physician The physician who may be the first to identify the symptoms of heart valve disease or other conditions that can cause heart valve disease or defects. He or she may order special tests to confirm the diagnosis or refer you to the appropriate specialist.

Cardiologist The physician who specializes in diseases of the heart. The cardiologist does not perform heart surgery but often performs diagnostic tests to identify the cause of heart problems and determine the course of treatment to manage heart disease. The cardiologist may prescribe medications and/or refer you to a cardiovascular surgeon.

Interventional Cardiologist A cardiologist who specializes in minimally-invasive, non-surgical methods of treating heart and vascular disease.

Kamran Muhammad, MD, FACC, FSCAI Dr. Muhammad is a subspecialist in interventional cardiology with Oklahoma Heart Institute. With advanced training in structural heart disease intervention from the world-renowned Cleveland Clinic, Dr. Muhammad serves as the Director of the Structural Heart Disease Program and Transcatheter Aortic Valve Replacement Programs at Oklahoma Heart Institute. Dr. Muhammad led a team of OHI physicians in performing the first TAVR and TMVR in Tulsa and the region.

Wayne N. Leimbach, Jr., MD, FACC, FSCAI, FCCP, FAHA, FACP Dr. Leimbach is a specialist in interventional cardiology. He is Director of the Cardiac and Interventional Laboratories at Oklahoma Heart Institute Hospital and also is Chief of Cardiology. Dr. Leimbach is Co-Founder of the Lipid and Wellness Clinic at Oklahoma Heart Institute. He is Director of the James D. Harvey Center for Cardiovascular Research at Hillcrest Medical Center, as well as Director of the Oklahoma Heart Research and Education Foundation.

7

TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR)

WRTAeROhpaARltaNTciSIseCCmTAVreTAannHLts?VEcETaEtRhREePteLrAACoErMticENVTalv(TeAVR)

IWf ahactairsdTiaracnssucartgheeotenr dAeotretircmVianlevesRthepaltayceomueanrte? at high risk or too sIifcakcfaorrdioapc esunr-gheeoanrtdsetuerrgmeirnye,sTthraant ysocuatahreetaetrhAigohrrtiisckVoarlvtoeo sick for Roeppenla-hceeamrtesnutrg(eTrAy,VtRhi)s iiss aa lleessssininvvaasisvieveprporcoedcuerdeutrhea.t TalAloVwRs aallnoewws a nwvsetaiiwtllhvl eboaeutooatrtibtoniecpgi.evnnaseilnvrtgeedytoowubitrehciinnhyseoesurttraedndidswewaisthehdiilneaoyyrootiuucrrvdhalievsaeerawtsihesidlsetayiololrubtriechaevtaianrltvgie.s Transcatheter aortic valve replacement (TAVR) is a state-of ?the-art alterTnAatVivRe itsoaopsetan-thee-oarft-tshuerg-aerrty.alItteirsnmatinivime atollyoipnevnas-hiveea,rrteqsuuirrgees rlye.ssItreiscovmeriynitmimael,lyanidnvthaesrieveis, lreesqsupiariens. less recovery time and is less painful.

TTrraannsfsemfeormaloTrAaVlRTPAroVceRdurPe r(ToFc-TeAdVuRr)e (TF-TAVR)

? AinApyproroouccreedldeuugrerethtaht aistaipsparopapcrhoeadcthhreodugthhtrhoeufgemhotrhael afretemryoirnayl oaurrtelergy ? TTrereaatmmeennt tfofropraptiaentitesnwtisthwseitvherseesvyemrpetosmymatipctaoomrtiactsitcenaoosristic stenosis ? Approved for patients who are either too sick or are cAopnpsriodveerdefdorhpigathie-nritsskwfhooratreraeditihteior ntoaolsoicpkeonr-ahreeacrotnssuidregreedryhigh-risk for

traditional open-heart surgery

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