BOWLING GREEN Jerry Roy, MD, of Bowling Green, Kentucky. has served southwestern Kentucky practices for a few years. He is an interventional and structural cardiologist for the Graves-Gilbert Clinic, the Bowling Green Medical Center, and TriStar Greenview Regional Hospital. The Chicago native started his medical education at Arizona State University Medical School, spent a couple years studying in the Caribbean and finished his degree back home in Chicago.
When Roy started practicing in Bowling Green, he noticed that many of the critical-care patients were sent from local medical centers to Nashville or Louisville, only to be told that open-heart surgery was their only option. Aware of newer treatment modalities, Roy aimed to bring more minimally invasive procedures for aortic stenosis patients — when and where they needed it. Consequently, he proposed treating dysfunctional aortic valves with a procedure called TAVR, or transaortic valve replacement.
Roy, with the help of local cardiothoracic surgeons Paul Moore, MD, and Wallace Carter, MD, and cardiologist Mohammad Abdoul Waheed, MD, helped establish the TAVR program in Bowling Green in 2016. The Heart Team approached patient care cautiously — carefully screening each individual to ensure they were ideal candidates for the procedure and minimizing potential risks.
What Is TAVR?
This minimally invasive surgical procedure repairs the valve without removing the old, damaged valve, usually on patients considered too fragile for open-heart surgery. Instead, it wedges a replacement valve into the native aortic valve’s place. Doctors may choose a variety of approaches, depending on anatomy and risk factors. Roy cites the most promising results are from the trans-femoral route.
Nearly 15 percent of adults aged 75 and older have some form of aortic stenosis. Roy says that calcium buildup within the valve causes the condition in older patients, and if earlier likely due to bicuspid valve degeneration. Consequently, the geriatric and structural nature of the disease prompts doctors like Roy to treat patients as close to the onset of the disease as possible, shifting the preferred treatment age back as earliest as possible.
A Promising Procedure
Almost three years have passed since the TAVR program’s inception at GGC. Roy and his team are celebrating overwhelming success. Patients come in for a minimally invasive, inpatient surgery and leave the hospital within two or three days – not a week as with open-heart surgeries.
At first, only high-risk patients received the procedure, patients who were too fragile for surgery. With the successful prognosis of those patients came FDA approval to widen their reach: The program was unanimously approved to expand to a broader population. Now, the Heart Team is performing the same procedure on intermediate risk patients and hopes to serve the low-risk patient base next year. This new influx could include a middle-aged group hoping to prevent a host of future cardiovascular problems.
Roy adds, “In Europe, they perform more of these procedures than standard aortic valve replacement. I envision this becoming the U.S. norm within the decade.”
Patient Challenges and Opportunities
Roy explains that the most challenging patients to treat have suffered long, untreated symptoms of diseased valves. Due to congestive heart failure and comorbid valve conditions, the heart’s function can remodel and deteriorate, complicating surgery.
He references patients with severe cases and early diagnoses as the choice candidates for the TAVR procedure. Due to the ubiquity of obesity, Roy doesn’t think it poses a significant challenge during operation.
So far, patient feedback has been overwhelmingly positive. Patients rejoin their families in a couple days and feel improvement almost immediately, usually through early ambulation. The same instant gratification that motivates Roy, ignites patient enthusiasm post-operation. And, in his words, their joy “spreads like wildfire.”
Roy notes how well the small city has adapted to innovative medicine: “With this TAVR clinic collaboration, Warren County is moving toward more minimally invasive, high-tech procedures.”
Due largely to the work of the Heart Team, they compete with the most reputable medical centers in the country. Roy owes this success to the team’s collaboration and attention to detail: “There are very few times in medicine when we implement a team approach. When this valve clinic came to life, it was the first time I’d witnessed a truly collaborative approach, all devoted to one patient.”
Roy adds, “Our continued growth speaks to our meticulous care we give each individual. We are all careful proceduralists, thinking through each approach before, during, and after the procedure. Each patient has a skilled heart team dedicated to their best result.”