Hoag Hospital in Newport Beach recently hit a notable milestone in the realm of cardiothoracic surgery—its 500th procedure using transcatheter aortic valve replacement, or TAVR, which is a non-invasive alternative to open-heart surgery.
“With TAVR, it really has been a game changer for the treatment of aortic stenosis—and a game changer in a relatively short period of time,” Anthony Caffarelli, M.D., told the Business Journal.
Caffarelli has been working with TAVR since 2007 when it was first introduced in clinical trials.
In 2012, Irvine-based Edwards Lifesciences Corp. released a new TAVR valve followed in close pursuit by Minneapolis-based rival Medtronic PLC. The two companies now control about 90% of the market.
Edwards (NYSE: EW), Orange County’s largest public company with a market value of nearly $40 billion, said that more than 350,000 patients have undergone the non-invasive TAVR treatment since first getting regulatory approval about a dozen years ago.
Hoag Hospital, home to the Nancy & Bill Thompson Heart Valve Center, is said to have completed the most TAVR procedures of any location in Orange County.
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The TAVR procedure repairs the heart valve without removing the old damaged valve. A new heart valve can be inserted through a small opening from the femoral artery of the leg.
“Originally, it was designed for older patients where the risk of open-heart surgery was too great, and, now intermediate patients are being considered for the procedure,” Caffarelli said.
Hoag is unusual because it isn’t affixed to a university like University of California-Irvine, Stanford University, or University of Southern California. Hoag relies on the close relationship with medical device companies to drive clinical trials at the hospital.
“It’s a proud day for our team and our patients—our partnership with different manufacturers helps us bring the right products to the right patients and we’re fortunate enough to be in a robust area of technology,” he said.
“We have a good, solid quality team that provides outcomes with good seamless interactions that we can do clinical trials that are normally held only at universities.”
When it comes to who has the better product, Edwards or Medtronic, Caffarelli said the answer relies on the anatomy of each patient.
“Each valve offers its own benefits and its own drawbacks and as with anything in medicine, you have to specify to the patient and choose the right valve,” he said.
“The partnership that Hoag has with Edwards and Medtronic—we work very seamlessly with them.”
Didn’t Feel Like Surgery
A patient in his mid-80s named Robert told the Business Journal about his experience during a visit to the center this month.
Problems with his heart wasn’t an urgent matter initially until he got shortness of breath while walking up the stairs.
“I remember telling my wife—honey, would you be upset if we didn’t go on the vacation? Because we were supposed to go on vacation,” he recalled.
After meeting his cardiologist, Dr. Subbarao Myla, the decision was made for Robert to do the TAVR procedure—something that ultimately saved his life.
Robert spent only one night in the hospital. He was told not to drive for four days and then after that, he went back to living his normal life, including the vacation he and his wife planned.
“I felt like I didn’t even have surgery—I felt great,” he said.
Caffarelli has personally performed several hundred TAVR procedures in the past decade. He doesn’t keep count, saying he cares more about the results.
“For the second year in a row, we are in the top 10% for performing aortic valve replacement—that’s the highest you can get,” Caffarelli said.
“The trials for this year showed that for low-risk patients—again, this is very specific criteria—these patients saw benefits.”
However, the government has yet to approve the procedure for low-risk patients.
