Appointment Icon

St. Luke's Emergency Department

First Available Time :

Jones Regional Medical Center Urgent Care - Anamosa

1795 Highway 64 East
Anamosa, IA 52205

00 Patients
Waiting Now

UnityPoint Clinic - Express (Lindale)

153 Collins Road Northeast
Cedar Rapids, IA 52402

00 Patients
Waiting Now

UnityPoint Clinic - Express (Peck's Landing)

1940 Blairs Ferry Rd.
Hiawatha, IA 52233

01 Patients
Waiting Now

UnityPoint Clinic Urgent Care - Marion

2992 7th Avenue
Marion, IA 52302

00 Patients
Waiting Now

UnityPoint Clinic Urgent Care - Westside

2375 Edgewood Road Southwest
Cedar Rapids, IA 52404

01 Patients
Waiting Now


Ep. 100 - LiveWell Talk On...Transcatheter Aortic Valve Replacement (Dr. Aref Bin Abdulhak)

episode 100

Ep. 100 - LiveWell Talk On...Transcatheter Aortic Valve Replacement

   Subscribe so you never miss an episode!

   Apple Podcasts | Google Podcasts | Spotify | Pandora | iHeart Radio |   
   Google Play Music | Stitcher TuneIn SoundCloud 


Host: Dr. Dustin Arnold, chief medical officer, UnityPoint Health - St. Luke's Hospital

Guest: Dr. Aref Bin Abdulhak, cardiologist, St. Luke's Cardiology

Dr. Arnold:
This is LiveWell Talk on transcatheter aortic valve replacement. I'm Dr. Dustin Arnold, chief medical officer at St. Luke's Hospital. Aortic stenosis or narrowing of the aortic valve of the heart, is one of the most common and serious valve conditions a patient may suffer, that is according to the American Heart Association. Returning to the podcast today for the 100th episode, this historic episode on LiveWell Talk On, is Dr. Aref Bin Abdulhak. Cardiologist with St. Luke's Heart and Vascular Institute and St. Luke's Cardiology, to talk about the newest valve replacement procedure, transcatheter aortic valve replacement or as effectually known, TAVR. Welcome back for this historic episode. What is the most common cause of aortic stenosis in the United States?

Dr. Bin Abdulhak:
The most common cause is the degenerated aortic valve stenosis, meaning with the aging process, minerals, mainly calcium get deposited in the valve, and that will end up having restriction in the valve movement and eventually narrowing of the valve.

Dr. Arnold:
As the valve narrows. You know, I don't think, could you explain why that's significant?

Dr. Bin Abdulhak:
It is very significant for too many reasons. The obvious reason, it can shorten the patient's life. And it can also result in suffering besides the shortened life expectancy and heart failure symptoms and decrease the patient's quality of life.

Dr. Arnold:
Okay. What symptoms would the patient have for that?

Dr. Bin Abdulhak:
The classic symptoms are chest pain, fainting or passing out, and shortness of breath. Those are the three cardinal symptoms that are typically presented in patients with what we call it, severe aortic valve stenosis.

Dr. Arnold:
And is this, Aref, is this predominantly a disease of the elderly, or can younger people have aortic stenosis?

Dr. Bin Abdulhak:
That's a pretty good question. It depends on what we call it, the etiology, but certainly younger patients in their fifties and sixties. If they do have what we call it bicuspid aortic valve, meaning typically the aortic valve has three cusps or three leaflets. Some people they were born with only two leaflets. And when the valve has only two leaflets it developed into degenerate faster. So certainly people in their fifties and sixties, they may have the aortic valve stenosis. And outside the United States and other parts of the world, they may have rheumatic valve stenosis, which is obviously less prevalent here, but they may have it at a younger age as well.

Dr. Arnold:
Yeah. The good rule of thumb is if they were born after 1944, the chance of rheumatic heart disease goes down dramatically because why? Penicillin.

Dr. Bin Abdulhak:
Correct.

Dr. Arnold:
So that valve becomes stenotic or narrowed, right. Previously the option was cut the chest open, put either mechanical or a pig valve bioprosthetic. But now we have something else called the TAVR. Can you explain what that is?

Dr. Bin Abdulhak:
Sure. Yeah, absolutely right. 20 years ago, this problem, the aortic valve stenosis is a mechanical problem. There's no pills that will treat this issue. And in the past, like 20 years ago, the only option is an open-heart surgery bypass machine, then replacing the valve with either bioprosthetic valve or mechanical valve. Now in the last maybe 10 years or so, with the advances in technology, we are able to replace the valve through the catheter—either from a small incision in the groin, going groin blood vessels to the heart, or if the groin is not suitable we can use what we call a tentative access. Sometime we have to go from the neck. Sometime we have to go from the arm with the valve being cramped on the catheter to the native aortic valve, then positioning the valve in the spot that we would like it to be, then expanding the valve with the catheter. And for most parts, if everything went very well for the patient, we can send them home next day.

Dr. Arnold:
Wow. Because previously it require extended ICU stay, extended hospitalization, cardiac rehab after having open-heart surgery to replace the valve. Correct?

Dr. Bin Abdulhak:
That's very correct. And in my training, especially with the COVID-19 pandemic, we sent a few patients home the same day.

Dr. Arnold:
Wow. And for the viewers of the broadcast today of the episode, we will have a diagram of the TAVR. It is worth looking at. It's really interesting. I always see these innovative procedures, I always think, wow, who's the first patient. First of all, who's the doctor that thought of it. You know, I'm always like, man, that is so impressive. And then it's also, well, who's the first patient said, yeah, you can try that on me. You know, I always wonder about that. But one of the, I know we have some other drugs, but they're not indicated for valve disease, but one of the things that patients and their physicians just dread, or not one of their favorite things to do is put someone on Coumadin or warfarin. Or rat poisoning, as some patients would call that. Now, do you need Coumadin after you have a TAVR procedure?

Dr. Bin Abdulhak:
Now, if there is no other indication for the anticoagulant, meaning the Coumadin or a Coumadin-like medication, we don't need it. Most of the time, we prescribe the baby aspirin and additional blood thinner for six months, and then a baby aspirin afterward. Now there are some studies that has showed maybe just a baby aspirin and is enough, but that's not a practice that has been widely used, at least here in our institution.

Dr. Arnold:
I think you're being a little humble here. First of all, you did a fellowship in structural heart disease. You're very well-trained from that standpoint, but also St. Luke's just recently got recognized as a center of excellence for TAVR, correct?

Dr. Bin Abdulhak:
That is correct. And we are very proud of that achievement. And just to add to the good news, we have had a patient a few months ago, that she basically run out of the access. There were no other options of doing the transcatheter replacement, other than what we call it, the transcaval access. We were the first in the Cedar Rapids area at least, to perform this procedure.

Dr. Arnold:
Wow. And now you do partner with our cardiothoracic surgeons. They're part of the team. What is their role?

Dr. Bin Abdulhak:
The procedure, we do the procedure together. An interface cardiologist and a cardio thoracic surgeon, by the regulation they have to be in the room together, doing the procedure. Sometimes we share the tasks and we work very collaboratively together. Like the intervention cardiologist may do the access and the cardiac surgeon will deploy the valve or the other way around, but we work very closely as a team.

Dr. Arnold:
Okay. Now, if I'm a patient and I have aortic stenosis and I know that, when would I be considered for the TAVR, as opposed to open heart surgery or just simply observation?

Dr. Bin Abdulhak:
Very good and timely questions. The American Heart Association, American College of Cardiology has released just a few months ago, I think a few weeks ago, new updated guidelines that for most part provide us with a roadmap. Outlining which patient would need to go for maybe an opposite surgery and which patients will go for a transcatheter. And it's extremely important also, that we take the patient decision and interests into consideration. If the patient is relatively young, fifties/sixties, and there is not much prohibitive surgical risk, I would prefer they have an open heart surgery and replace the valve. If the patient is about the age of 65/70, and especially if there is a loss of co-morbidities, maybe replacing the valve with the transcatheter approach is the better way to go. But the decision process is not an easy and it involves the heart team decision and we'll take the patient interests and consideration also into account.

Dr. Arnold:
So does the TAVR, it improves the symptoms of this stenosis, does it also extend life of the patient?

Dr. Bin Abdulhak:
Absolutely. Well, first if the patient has severe symptoms of symptomatic aortic stenosis, there is no role for just an observation. Just back to your question, when get to the severe stage and especially with symptoms, the aortic valves need to be replaced. Of course, if the patient is interested in the procedure. Since our talk is about TAVR specifically, it is just not only for symptoms relief, it's also for a survival benefit.

Dr. Arnold:
That's good to know. Yeah. I mean, in my twenty-five years of practice, I've certainly had those patients that weren't surgical candidates for aortic stenosis. And, you know, their life was miserable between bouts of flash pulmonary edema. And, you know, their functional capacity was really limited. So this, this is something that is, this is a big deal, isn't it?

Dr. Bin Abdulhak:
It is, indeed.

Dr. Arnold:
Well hey, thank you for taking time out today to talk about this. I think it's really exciting. And we look forward to TAVR Tuesdays, kind of like taco Tuesday, if you're old enough to remember that. But again, the discussion today was transcatheter aortic valve replacement, or TAVR. And this is Dr. Aref Bin Abdulhak, cardiologist with St. Luke's Cardiology and St. Luke's Heart and Vascular Institute. Thank you, my friend.

Dr. Bin Abdulhak:
Thank you for having me again. Thanks.

Dr. Arnold:
Thank you for listening to LiveWell Talk On. If you enjoyed this episode, don't forget to subscribe. And if you want to spread the word, please give us a five-star review and tell your family, friends, neighbors, strangers, about our podcasts. We're available on Apple Podcast, Spotify, Pandora, or wherever you get your podcasts. Until next time, be well.