Structural heart disease includes both congenital and acquired disorders of the heart valves or chambers. At Cone Health, specialists from multiple disciplines work together to find the best treatment options for people with these conditions, including catheter-based interventional procedures and minimally invasive cardiac surgery. Transcatheter Aortic Valve Replacement (TAVR) Aortic stenosis, or narrowing of the aortic valve, becomes more common as people age. It often requires surgical treatment, and until recently, open-heart surgery was the only option. Cone Health is one of the few health centers in the region to offer TAVR – a faster, less-invasive way to treat severe aortic stenosis. During the procedure, surgeons implant an expandable bioprosthetic tissue valve inside a diseased aortic valve, holding it in place with a metallic stent. While conventional valve replacement surgery requires temporary support of the patient’s circulation using a heart-lung machine, TAVR is performed while the heart is beating. The treatment provides patients with quick relief from aortic stenosis symptoms, and most can get back to normal activity within a week or two. Since 2014, the Cone Health Heart and Vascular Center has performed more than 100 TAVR procedures. Structural Heart and Valvular Disease Minimally Invasive Cardiac Surgery Minimally invasive surgeries available at Cone Health have transformed the treatment of heart valve disease in our community. We routinely repair or replace damaged valves through very small incisions in the chest – resulting in less trauma, pain and bleeding. Patients tend to have a shorter hospital stay and a much faster recovery. Our minimally invasive options are available for: • Mitral valve repair or replacement. • Aortic valve replacement, including rapid-deployment aortic valves. • Closure of atrial septal defects, including large and complex defects. • Tricuspid valve repair. • Maze procedure. • Watchman device implant (see p. 32). Mitral Valve Repair Some degenerative conditions can lead to mitral valve regurgitation, or leaking of blood back into the heart. They include mitral valve prolapse, rheumatic heart disease, ischemic heart disease, non-ischemic cardiomyopathy, infections (endocarditis) and congenital defects. Mitral valve repair, rather than replacment, has shown excellent and durable results among our patients. ASD/PFO Closure Our Heart and Vascular Center specialists have experience closing two types of defective openings in the upper chambers of the heart: atrial septal defects (ASD), which can lead to heart failure, and patent foramen ovale (PFO), a condition that increases stroke risk. The FDA approved PFO closure in October 2016 to help prevent recurrent strokes. The Heart and Vascular team collaborates with neurologists to identify appropriate candidates for the procedure. Michael Cooper, MD, and Clarence Owen, MD, co-directors of the Multidisciplinary Heart Valve Clinic for Structural Heart Disease, perform the TAVR procedure. Cone Health holds three-star ratings — the highest rating — in Coronary Artery Bypass Grafting (CABG), for July 2016 to June 2017, as well as Aortic Valve Replacement (AVR) and combined AVR+CABG, for July 2014 to June 2017. Historically, approximately 5 to 7 percent of participants nationally receive the three-star rating for AVR+CABG surgery. – Society of Thoracic Surgeons 16 17 CONE HEALTH | HEART AND VASCULAR CENTER CONE HEALTH | THE NETWORK FOR EXCEPTIONAL CARE