Thank you for choosing the Transcatheter Heart Program at Westchester Heart and Vascular, northern New York City, Westchester County and the Hudson Valley's leading heart and vascular diagnosis and treatment center--based at Westchester Medical Center; the only facility in the region offering transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. Our team of cardiac specialists are here to provide you with compassionate and exceptional cardiovascular care. Please take a moment to review our background information about our Program and the procedure.
Minimally Invasive Aortic Valve Replacement with TAVR
There are currently two treatment options for severe aortic stenosis. The first option involves the replacement of the valve by open heart surgery, a procedure called aortic valve replacement (AVR). The second option involves replacing the aortic valve using a catheter, avoiding open heart surgery. This procedure is often abbreviated TAVR which stands for Transcatheter Aortic Valve Replacement, or TAVI (Transcatheter Aortic Valve Implantation).
Westchester Medical Center is proud to be one of a few hospitals to offer TAVR in New York and the only one in Westchester County and the greater Hudson Valley and Fairfield County, CT to offer this service. The Medical Center's heart specialists will perform transcatheter aortic valve replacement (TAVR) using the Edwards Sapien valve, FDA-approved for the treatment of severe aortic stenosis. This procedure will be performed in the Medical Center's new hybrid operating room. Take a look at the educational videos below, highlighting the two treatment approaches.
How TAVR is Performed at Westchester Medical Center
TAVR with the Edwards Sapien valve is commonly performed from the groin via your leg artery (transfemoral) or from the heart apex (transapical) between your ribs, depending on a number of factors. A third option is to deliver the valve directly from your aorta with a small chest incision (transaortic). Our multidisciplinary cardiovascular team will determine which is the best approach for you.
1. The Edwards Sapien replacement aortic valve is first mounted on a catheter...
2. The replacement valve is then crimped and the catheter housing it is threaded through a delivery system and deployed across the recipient's aortic valve. After valve deployment, the catheters are removed and a closure device is used to seal off the incision, leaving only a small needle mark on the patient's skin.
Videos: Edwards SAPIEN device in action
Take a look at the educational videos below, highlighting the two treatment approaches. All TAVR procedures are performed in the Medical Center's hybrid operating room. Note: video resolution may vary depending on the device you are using. Resolution can be adjusted from settings in full screen view on a PC.
Edwards SAPIEN Transcatheter Heart Valve with the RetroFlex 3 Transfemoral Delivery System
Edwards SAPIEN Transcatheter Heart Valve with the Ascendra Transapical Delivery System
Transfemoral deployment of heart valve during TAVR procedure at Westchester Medical Center.
Transapical deployment of heart valve during TAVR procedure at Westchester Medical Center.
Transaortic deployment of heart valve during TAVR procedure at Westchester Medical Center.
Transcatheter Heart Program TAVR Physician Referral and Patient Self-Referral
Transcatheter aortic valve replacement (TAVR) is the lastest and one of the most innovative procedures to treat aortic stenosis. The Transcatheter Heart Program at Westchester Medical Center is this region's only program providing this service, delivered by the capable heart and vascular specialists at Westchester Heart & Vascular.
Referring physicians are encouraged to complete a referring form on their patients' behalf. Patients can also self-refer themselves to be considered for a consultation.
Location, Parking, Contact
Westchester Medical Center is among less than 5 hospitals to offer TAVR in New York. Our Transcatheter Heart Program is conveniently located in Westchester County with easy access from northern metropolitan New York City, Northern Westchester, Orange, Rockland and Dutchess Counties. Parking is located outside our building and is free. Valet parking is also available. If you need to visit the Medical Center for any testing, we will provide you with a parking voucher.We are located at:
19 Bradhurst Ave, Suite 3750S Hawthorne, NY 10532 Phone: (914) 909-6909 | (914) 830-1098
Westchester Medical Center Transcatheter Heart Program Participation
What can I expect on my first visit? Your first visit at our clinic will be scheduled with the cardiothoracic surgeon and the valve clinic coordinator. This visit is approximately 1.5 - 2 hours long. You may take all of your medications as usual for this visit. You may also eat your meals as usual. There is no reason to fast for this visit. We will provide you with meal vouchers for the day.
The cardiothoracic surgeon and program coordinator will meet with you and your family members to discuss any questions you may have. We will perform a frailty assessment and do labwork. We will review any **cardiac testing you have had done, and help you get scheduled for any additional tests you may need. The required tests can be performed by your own cardiologist or may be done at our office or at the Medical Center, whichever is convenient for you.
The following tests will be performed:
Echocardiogram (or echo) will also need to be performed at our facility
*Cardiac CT (256 slice) and CT with contrast the chest, abdomen and pelvis
Carotid duplex ultrasound
Pulmonary function tests to check your breathing
*If you are scheduled for a CT Scan on your first visit, you will receive special pre-testing instructions from our coordinator.
**Please have your doctor’s office fax the results to us before your first visit. Please send all reports and discs to:
Andrea Cronin, FNP-C Valve Clinic Coordinator 19 Bradhurst Ave Suite 3750S Hawthorne NY 10532 Phone: (914) 909-6909 | Fax: (914) 493-2858 | Email: firstname.lastname@example.org
I've had my first visit with the Transcatheter Heart Program, what can I expect next? We will contact your cardiologist at the end of your initial visit to discuss our recommendations. If our team of cardiothoracic surgeons feel you are a candidate for surgical replacement of your aortic valve, we will give you the information you need to arrange for that procedure. If we feel you are a candidate for transcatheter aortic valve replacement (TAVR), we will arrange for any additional required tests you may need to have. We will discuss the recommendations with your cardiologist, and have you return for a second clinic visit.
What happens on the second visit? The second visit will last approximately one hour. Please eat your meals take your medicines as usual. Again we will provide parking and meal vouchers.
During the second visit, you will see your cardiothoracic surgeon and meet the interventional cardiologist at that time. We will discus the plan with you and your family and answer any questions you may have. We will perform a basic neurological assessment and we may also repeat blood work at that visit. Your TAVR procedure may be scheduled following the second visit.
What is aortic stenosis? Your heart has 4 valves. The aortic valve (AV) controls the flow of blood between the left ventricle, which is the main pumping chamber of the heart, and the body. As you age, the aortic valve can become calcified and narrowed. This condition is known as Aortic Stenosis. Learn more about severe aortic stenosis and treatment options at http://newheartvalve.com
What are the symptoms of aortic stenosis? Patients with aortic stenosis often have no symptoms until the valve becomes progressively narrowed. Symptoms include chest discomfort (angina), light-headedness, fainting (syncope), shortness of breath or heart failure. Symptoms of worsening aortic stenosis include decreased energy level, fatigue, and bleeding. If you experience these symptoms and signs you should consult your doctor urgently to determine the severity of your condition.
How is aortic stenosis diagnosed? An echocardiogram is a simple test that uses ultrasound waves to look at the heart and the valves to assess whether or not someone might have aortic stenosis. The area of the aortic valve can be measured during an echocardiogram to determine the degree of aortic stenosis someone might have. It is usually classified as mild, moderate or severe. This procedure is usually done in a physician’s office or imaging office.
Aortic stenosis can also be diagnosed by performing a cardiac catheterization. This procedure is performed in a hospital by an interventional cardiologist. Small catheters are placed through the artery in the leg and threaded up to the heart to measure the degree of narrowing of the aortic valve.
What is the current treatment of severe aortic stenosis? If your aortic valve is severely narrowed, your doctor will discuss options with you. There are no medications that can halt or slow down the progression of aortic stenosis. If you do not have symptoms with good heart function, then close observation may be adequate. However, your doctor may perform a stress test which can often elicit hidden symptoms, such as fatigue. If you have symptoms, you need an urgent consultation with your doctor.
What if I don’t want anything done for my aortic stenosis? There is no medical treatment for aortic stenosis. If you have mild or moderate aortic stenosis you can follow up with your doctor and he or she will advise you what to do. However, if you have severe aortic stenosis and symptoms, you need to seek urgent medical attention. In cases where individuals cannot undergo surgery or TAVR, balloon aortic valvuloplasty (BAV) may be another option.
Transcatheter Aortic Valve Replacement (TAVR) Effectiveness and Benefits
Am I an ideal candidate for TAVR/TAVI? TAVR is a new treatment alternative to surgical aortic valve replacement (AVR) for patients who have symptoms from severe aortic stenosis, but are considered prohibitive risk or high risk to undergo surgical AVR. Our team uses an established checklist and other factors to determine if you will be eligible for TAVR. If you or someone you know of have a known heart murmur, consult a physician for a possible diagnosis of aortic stenosis and see if you may be eligible for TAVR.
How effective is TAVR/TAVI? Studies have shown that TAVR is as effective as surgical AVR in high risk patients and is better than medication in prohibitive risk patients who are considered too high risk for open heart surgery.
Westchester Medical Center's Transcatheter Heart Program Team is one of the first in the world to use 3D CT and M2S imaging software to optimize valve positioning and deployment angle in TAVR, achieving outstanding results and minimizing adverse radiation and dye impact on patients. Click image for details.
How will TAVR benefit residents of the Lower Hudson Valley region? Prior to Westchester Medical Center's new Transcatheter Heart Program, this treatment was not available in Westchester County and the Hudson Valley. Patients no longer have to worry about traveling to New York City to have the TAVR procedure done. Being closer to home will make scheduling appointments easier and your follow-up with your cardiac surgeon and cardiology team will be much more convenient.
Will I be awake for the procedure? You will not be awake for the procedure. You will receive general anesthesia, just as you would for surgical aortic valve replacement.
I have other medical issues in addition to aortic stenosis, how will that affect whether or not I am eligible for the procedure? Our Transcatheter Heart Program team includes multidisciplinary specialists, such as internists, endocrinologists, neurologists, renal (kidney) specialists, nutritionists and social workers who work together with our cardiologists and cardiothoracic surgeons. Together our team will assess your medical history and existing health condition to determine your eligibility for the TAVR procedure. A part of our comprehensive approach to your care includes the involvement of medical specialists who collaborate to ensure a treatment plan specific to your needs and current health. Our team will, for example, consider existing conditions such as diabetes, liver or kidney problems, and any other existing health problems you might have--in addition to aortic stenosis when planning your treatment course. Westchester Medical Center is also highly ranked both nationally and regionally for heart care and cardiac surgery.
What is the age limit to be a candidate for TAVR? There is no age limit for TAVR. The majority of TAVR patients are in their late 70’s to 100s.
What kind of tests or pre-testing will I need to go through to be considered for TAVR? To be considered for TAVR, you will visit us at our Transcatheter Heart Program location in Westchester, NY where our cardiology team will assess your current health condition and medical history and determine if you are an ideal candidate for the TAVR procedure. After that, you will undergo a series of lab and imaging tests.
I have been told I have kidney issues, how will that affect my ability to have the CT scan for TAVR evaluation? We offer consultation with our nephrologist during your clinic visit, or we consult with your internist or nephrologist to review your kidney condition and your ability to undergo a cardiac CT and CT with contrast of the chest, abdomen and pelvis. There are several options to prepare you for the CT study. Alternatively, transesophageal echo is another imaging study that can evaluate your aortic valve anatomy. Our team of interventional cardiologists, echo cardiologists, cardiac surgeons and cardiac radiologists work closely together to provide the imaging study you need for TAVR evaluation.
How long does the TAVR/TAVI procedure take? The TAVR procedure itself takes approximately 2 hours, but will require additional time to get you prepared; placement of monitoring lines, anesthetic induction and room setup.
Will I be able to go home on the same day after the procedure? You will not go home on the same day of the transcatheter aortic valve replacement procedure. You might however, be admitted to the hospital the day before the procedure.
How long is the hospital stay? The hospital stay, on average, is approximately 7 days. However, some patients might recover more quickly and might be eligible for discharge before 7 days.
If I’m selected for the procedure, how will I know if my health insurance will cover TAVR? Our billing specialists will work with the Transcatheter Heart Program team to determine your insurance coverage for the procedure.
Will I feel better after the TAVR procedure? A majority of patients without lung and other existing heart problems can expect improvement of their symptoms, reduced chest discomfort, as well as a reduction in feelings of light-headedness and shortness of breath.
How long will the recovery process be after the TAVR procedure? After discharge from the hospital, it takes on average 2-3 weeks to fully recover from TAVR. Our patients are expected to be able to walk about unassisted 1 - 2 days after the procedure. Some patients will be eligible to return home following the procedure and the required hospital stay. Other patients might benefit from additional rehabilitation services after the procedure either as an inpatient or outpatient. Our team of social workers at the Transcatheter Heart Program will work closely with you and your family to determine the best course for you.
What kind of follow-up will I need? TAVR patients will participate in a comprehensive follow-up program to ensure full-recovery and an improved quality of life. A component of the follow-up program will be incorporated into the national Transcatheter Valvular Therapy (TVT) database. Your first follow-up visit with us after the TAVR procedure will be 4 weeks, then 6 months and 12 months, or earlier if necessary.
Can I request the TAVR procedure even if I’m a candidate for traditional open chest surgery but not high risk? You or your doctor may request an evaluation for the TAVR procedure. The TAVR team will determine which procedure is best for you.
I notice that a couple other hospitals in the region provide the procedure, what sets Westchester Medical Center's Transcatheter Heart Program apart? Three things set us apart from other TAVR programs: excellence, accessibility, and convenience.
EXCELLENCE: Westchester Heart & Vascular's new TAVR program has been built on Westchester Medical Center's reputable cardiology program. Our cardiothoracic surgery team has delivered exceptional outcomes for surgical aortic valve replacement (AVR) including in high risk patients. Our interventional cardiologists have also achieved high success rates in their specialties. Our cardiothoracic surgeons and interventional cardiologists have trained in transcatheter aortic valve replacement procedures at leading institutions, have a long history working together and will bring their expertise to this innovative therapy with the ultimate objective of improving our patients' quality of life.
ACCESSIBILITY: Our optimal location in Westchester County and regional proximity to your home will positively impact the quality and effectiveness of this treatment option. This means shorter travel distances for patients and their families when they need to make office visits, come in for the procedure and follow-up. This significantly reduces the length of time you will wait to receive care.
CONVENIENCE: Our Transcatheter Heart Program location is a model of efficiency. Patients can have all their required preliminary testing completed in one location, very often on the same day. Free on-site parking, including free valet parking, is also available to our patients and their families. The Medical Center is pleased to be among a select few hospitals to offer TAVR in New York.
Westchester Medical Center Transcatheter Heart Program Team
Westchester Medical Center's TAVR Team is featured in MD News talking about the innovative procedure and its impact on residents of the Hudson Valley, Westchester County and northern New York City. Click to download article.