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The multidisciplinary Heart Team at the San Francisco VA Medical Center (SFVAMC) has performed 11 successful transcatheter aortic valve replacement (TAVR) surgeries since November 2013, for Veteran patients who need, but cannot have, traditional open-heart surgery.
In the past, traditional surgery involved replacement of or rerouting of the aortic valve through heart surgery involving a large incision through the chest. For some patients, and the elderly or frail, the traditional surgery is too high-risk, and they wouldn’t survive. Until TAVR was available, there weren’t other options for treatment.
TAVR is a fairly new procedure used successfully in Europe and recently approved by the FDA for use in America. It’s less invasive (the entry point is a small incision in the leg) and cardiopulmonary bypass is usually not needed.  SFVAMC is one of the first VA Medical Centers, and the only VA on the West Coast, to have completed the rigorous VA approval process to be able to perform it.
“We now have something to offer patients with severe aortic stenosis who otherwise would not be eligible for heart surgery,” said Shunk. “This procedure is as good as the traditional surgery and recovery is much faster. Hospitalization averages only 3-5 days after surgery and then usually the patient can go home. The traditional surgery requires an average 10-day hospital stay and patients typically transfer from there to a skilled nursing facility for further recovery.”
Other benefits of TAVR vs. standard medical therapy is that within one year after the procedure, patients decreased their repeated hospitalizations by half, fewer needed a new pacemaker, fewer had kidney failure, and far fewer needed additional procedures on the operated valve, according to data supplied by Edwards Lifesciences Corp., the company that makes the transcatheter aortic valve used in TAVR surgeries.
“The main excitement for me is that this novel program that was so long in the preparation phases is now fully established,” says Dr. Shunk. “This procedure is now becoming relatively routine for members of the SFVAMC Heart Team. It’s been extremely gratifying to see the objective and symptomatic improvements in each of our patients who have undergone TAVR at SFVMAC to date.”
Veteran Dennis Born was SFVAMC’s first patient to receive TAVR surgery on November 25. Veteran Philip Hanley was SFVAMC’s second TAVR patient to experience it. “I have nothing but accolades for Dr. Shunk and his team,” says Hanley.  “I have always received outstanding services at this VA.”
According to Hanley’s wife, Linda, they were notified a week before that Philip would be having TAVR surgery. “Our 28th wedding anniversary was on November 24, and Philip had surgery on November 25. What a wonderful anniversary gift for us!”

Featured Story
January 28, 2019