St. Francis Hospital is recognized as a national leader in cardiology and heart surgery, repeatedly ranked by U.S. News & World Report as one of the best hospitals in the country in that category. Our hospital has consistently had the largest cardiac surgical volume in New York State since 1992. In fact, the NYS Department of Health has recognized our program for its outstanding success rates more than any other hospital in the New York metropolitan area.
Open-heart surgery has been the gold standard for treating severe aortic valve stenosis, offering a safe and effective treatment for patients who are not considered high risk. During the procedure, the surgeon makes an incision down the center of the sternum or breast- bone to get access to the heart. Patients are then placed on a heart-lung bypass machine, which takes over the function of both organs. This machine maintains circulation through- out the valve replacement procedure for which St. Francis Hospital has had excellent safety rates.
Transcatheter aortic valve replacement, or TAVR, is a new, minimally invasive procedure that channels a tube called a catheter containing a prosthetic valve through the femoral artery toreach the heart via one of several possible routes, including the femoral artery, subclavian artery, a direct aortic approach, or through the apex of the heart itself. If the patient’s femoral or leg arteries are large enough, this is the preferred approach. The procedure is typically used for patients who are too elderly or sick for open-heart surgery. St. Francis physicians currently use two devices for this procedure: MedtronicCoreValve or the Edwards Sapien Valve, which are now approved for intermediated risk, high risk and extreme risk patients. In addition, MedtronicCoreValve is available for low risk patients as part of a national clinical research trial. The St. Francis team has performed over 1,100 TAVR procedures, one of the largest volumes in the U.S.
Thoracic Endovascular Aneurysm Repair (TEVAR) is a minimally invasive procedure for the treatment of aortic aneurysms and dissections that does not require open chest surgery. Similar to endovascular aneurysm repair in the abdomen, TEVAR involves accessing the arteries in the groin, through which a synthetic device is advanced into the aorta. This device or graft excludes the aneurysm; not unlike patching a tire from the inside. This minimally invasive, endovascular approach, allows short hospital stays and a quicker recovery. It has emerged as the standard of care for patients with aneurysms and dissections of the descending thoracic aorta who have favorable anatomy. The technology has also been adapted to work in conjunction with open procedures to reduce time spent in surgery.
What to Expect During TEVAR
During the TEVAR procedure, a tube or catheter is inserted into the femoral artery in the groin. X-ray guidance is then used to direct a wire into the aneurysm in the chest. Over this wire is advanced a stent graft, in a collapsed state, inside of the aneurysm. The stent is then expanded to cover the diseased portion of aorta.
Patients typically are in the hospital for two to three days and can resume all regular activities within a month.
While not all aneurysms require surgery, it is generally recommended for aneurysms larger than 5 cm, or those that appear to be growing at a certain rate. Those with extensive aortic disease may require a combination of open surgery and endovascular repair. Patients with these conditions are evaluated by a multi-disciplinary team to best select and personalized treatment plan.
The Ross Procedure (Pulmonary Autograft Operation) is a surgical procedure used for treatment of aortic valve disease. During the procedure the surgeon removes the diseased aortic valve and replaces it with the patient’s own pulmonary valve. A donor valve is then used to replace the pulmonary valve. The pulmonary valve rapidly adapts to this new role and provides the patient with a durable valve replacement, not requiring of blood thinners, that is conducive to an active lifestyle.
The Ross Procedure is a highly technical operation, generally reserved for otherwise healthy and active patients under 60 years of age. It is also a good option for patients wishing to avoid anticoagulation, those who plan to have children, and patients with small aortic valves or patient/prosthesis mismatch from prior aortic valve operations.
Studies have found that patients undergoing The Ross Procedure experience long term wellness, akin to those without aortic valve disease. Rates of re-operation are low and rare within the first two decades after surgery.
What to Expect During a Ross Procedure
The Ross Procedure is an open-heart operation performed through a traditional incision in the chest. During the procedure, the patient is supported on a heart lung machine. The patient’s aortic valve is removed and the pulmonary valve is prepared for placement in the aortic position. Fine sutures are then used to anchor the new aortic valve into place. Aneurysms of the aorta are typically treated during the same procedure.
After surgery the patient will typically spend one to two days in our dedicated ICU for open heart surgery patients. An additional 3-5 days are spent in the hospital as medications are carefully adjusted. Patients are discharged home in most cases and recovery is complete within six weeks. Following their recovery, patients are able to return to a normal active life with no need for long term blood thinning medications.