First-in-Iowa procedure offers new TAVR option for patients with artery damage

Alan Leff in front of his University Heights home
After having Iowa’s first transcaval TAVR procedure, Alan can enjoy a leisurely walk around the block again.

When Alan Leff appeared to have run out of treatment options for a serious heart condition, the University of Iowa Heart and Vascular Center found a new one for him: a highly specialized procedure called transcaval transcatheter aortic valve replacement that had never been performed in Iowa before.

UI cardiologist Philip Horwitz, MD, used the technique—a newer approach to transcatheter aortic valve replacement (TAVR) for patients with artery damage who don’t qualify for a standard TAVR procedure—to replace Alan’s aortic valve without open-heart surgery.

Before the procedure, even a short walk left Alan out of breath and weak. Without treatment, his failing aortic valve would have greatly increased his chances of heart failure.

Today Alan takes a walk around the block three or four times a day, and his regular cardiac rehab appointments are building his stamina even more.

“I’m doing just fine,” Alan says. “It was very much a successful operation.”

Artery damage rules out standard TAVR

Alan, 84, of University Heights, Iowa, had severe aortic stenosis, a stiffening of the aortic valve that makes the valve narrower, forcing the heart to work much harder to pump enough blood.

He’d been diagnosed with mild stenosis about two years earlier, but an exam in 2020 found that the condition had advanced significantly. The valve needed to be replaced soon, but open-heart surgery was too risky for Alan.

For many people who need aortic valve replacement but can’t have open-heart surgery, TAVR is the solution. TAVR is minimally invasive. A new valve is placed in the heart with a catheter. The catheter is advanced through the patient’s arteries from a small incision in the leg.

Many TAVR patients leave the hospital the next day, and their recovery is much faster than if they had had open-heart surgery.

But because Alan has peripheral artery disease, he wasn’t a good candidate for a standard TAVR procedure. A CT scan showed that none of his arteries would allow reasonable access to the heart using a catheter.

Finding a different route with transcaval TAVR

Horwitz recognized that transcaval TAVR offered Alan the option he needed to have the valve replaced.

In transcaval TAVR, the catheter is advanced through veins instead of arteries. When it reaches a vein that is parallel to the aorta, the catheter crosses into the aorta, and the artificial valve is placed just like it would be during a standard TAVR procedure.

At the end of the procedure, the hole in the aorta is closed with a specialized plug.

UI approach to care is ‘a confidence builder’

Alan had the procedure on Tuesday and was home by the following Sunday. His walks are no longer hampered by his failing aortic valve, and within weeks he was making noticeable progress.

“I walk three or four times a day,” he says. “I’m to the point where I can walk a block without having to stop.”

He came away impressed by how the UI Heart and Vascular Center worked to give him the care he needed.

“Dr. Horwitz could have simply said I wasn’t a candidate for TAVR,” Alan says. “But he didn’t. He reached out and sought something else for me.”

Alan says the teamwork among Horwitz, Lana Goldsmith, ARNP, and Angela Kipp, RN, to coordinate his care and keep him informed made all the difference as he prepared to undergo the first-in-Iowa procedure.

“It was very gratifying to be working with them,” he says. “It was a confidence builder.”

Iowa’s most comprehensive TAVR care

The UI Heart and Vascular Center has performed more than 1,000 TAVR procedures since 2011, with a success rate of 99%, consistently higher than the national average.

The addition of transcaval TAVR means UI cardiologists have the most complete set of treatment options for severe aortic stenosis, including options for patients with the most complex cases. UI cardiologists were also the first in Iowa to use BASILICA, another specialized TAVR technique for patients with challenging heart structure who don’t qualify for a standard TAVR procedure.

University Heights, Iowa