Treatments & Services

Transcatheter Aortic Valve Replacement

Physicians at the Emory Heart & Vascular Center offer a minimally invasive treatment option for patients with severe aortic stenosis a narrowing of the aortic valve opening that affects tens of thousands of people each year. Recently, physicians at Emory recieved approval to perform transcatheter aortic valve replacement for inoperable patients, high risk patients as well as medium risk patients.

During transcatheter aortic valve replacement (TAVR), Emory interventional cardiologists and cardiothoracic surgeons place a new valve inside the heart without stopping the heart or opening the chest. Patients often recover more quickly from this minimally invasive approach.

 In large part as a result of more than 950 procedures performed by Emory’s skilled cardiovascular team during clinical trials, the valve used in this innovative procedure was originally approved by the U.S. Food and Drug Administration (FDA) for use in patients who were too ill or frail to undergo traditional open-heart surgery. More recently, Emory cardiothoracic surgeon Vinod Thourani, MD, helped present results to the FDA that eventually led to expansion of the TAVR approval to include patients who also qualify for the traditional open-surgical procedure.

Emory was the first center in the Southeast to perform this procedure and was one of the largest enrolling centers in the country for the pivotal PARTNER I clinical trial. The Emory Heart & Vascular Center is currently enrolling qualified patients in the PARTNER II trial, which was designed to evaluate the next generation of transcatheter aortic valve. Patients who do not qualify to participate in PARTNER II can be evaluated for TAVR using the FDA-approved device.

Key milestones accomplished by the Emory TAVR team

  • First center in the country to implant the commercially available transaortic Sapien valve
  • First center in the country to perform transapical valve-in-valve placement, in which a transcatheter aortic valve is placed directly through the wall of the heart to functionally replace a failing bioprosthetic valve
  • First center in the world to perform a transcarotid aortic valve replacement
  • Second center in the country to perform transfemoral valve-in-valve placement, in which a transcatheter aortic valve is used to functionally replace a failing bioprosthetic valve using femoral vein access

For more information or to schedule an evaluation contact Vasilis Babaliaros, MD, 404-712-7667, or Vinod Thourani, MD, 404-686-2513.

Balloon Valvuloplasty

Many patients with degenerative valve disease are ineligible for surgery because of their high-risk status (e.g., advanced age, multiple comorbidities or end-stage disease). For these patients, balloon valvuloplasty may be a viable alternative to open-heart surgery to reduce symptoms of the disease.

In balloon valvuloplasty, a catheter (thin, flexible tube) with a small, deflated balloon attached to the tip is threaded through a blood vessel. Once the catheter reaches the damaged valve, the balloon is inflated to stretch the valve opening and allow more blood to flow through it. The balloon is then deflated and guided back out through the vessel and removed.

The patient is generally awake during this procedure, and the recovery time is considerably shorter than with traditional surgery. However, balloon valvuloplasty is not a permanent solution and often has to be repeated at a later date.

Percutaneous Mitral Valve Clip Placement

In mitral valve clip placement, a catheter (thin, flexible tube) is used to deliver a small clip into the heart via the femoral vein. Once in place, the clip is attached to the leaflets ("swinging doors") of the mitral valve to improve their function, and the catheter is removed. Because the procedure is minimally invasive, the recovery time is substantially shorter than with open-heart surgery, the traditional method for treating mitral valve leaks.

Septal Defect and Patent Foramen Ovale Closure

In the past, many people with holes in their hearts have faced a lifetime of anticoagulant therapy or even open-heart surgery in order to reduce their high risk of stroke. Emory now offers a minimally invasive option to close a variety of cardiac holes, including atrial and ventricular septal defects and patent foramen ovales.

During these procedures, a hollow catheter (thin, flexible tube) is threaded through a blood vessel and guided to the site of the defect. Once in place, it is used to deliver a collapsed mesh closure device and place it inside the defect. The device is then activated, expanding to block the congenital opening and hold the device in place, and the catheter is removed. Recovery time following such a placement is considerably shorter compared with traditional surgery.

Left Atrial Appendage Closure

The left atrial appendage (LAA) is a small pouch in the left atrium. Patients with atrial fibrillation (abnormal heart rhythm) have a high risk of blood clots forming in the LAA. These clots can dislodge from the LAA and block blood flow to crucial parts of the body, including the brain (stroke). Oral anticoagulation medications may be used to reduce the risk of clots, but these medications are not safe or appropriate in some patients. In such cases, LAA occlusion is a viable treatment option.

In LAA occlusion, a catheter (thin, flexible tube) is used to deliver an closure device to the left atrium. There, the device is inserted into the LAA and expanded like an umbrella to seal off the entrance to the pouch.

Coronary Fistula Closure

A coronary fistula is an abnormal connection between a coronary artery and a chamber of the heart or another vessel. Except for very small fistulae, they generally need to be repaired. Emory offers a minimally invasive procedure in which a catheter is advanced through a vein to the site of the fistula and a wire coil is placed to block the abnormal opening.

Pulmonary Vein and Artery Stenting

This procedure is used to open up a pulmonary vessel that may have narrowed for a variety of reasons. A stent is placed over a tiny deflated balloon and delivered to the narrowed portion of the vessel using a catheter (thin, flexible tube) fed through a vein. Once in place, the balloon is inflated, thereby expanding the stent and anchoring it in place. The balloon and catheter are then withdrawn.

Transcatheter Paravalvular Leak Closure
Re-operation to repair a leaking prosthetic valve is a very risky procedure for some patients. This minimally invasive technique uses a catheter to deliver and deploy a closure device at the site of the leak.
Transseptal Puncture

Due to coronary anatomy, the left atrium is difficult to access for interventional treatment. Transseptal puncture is the technique of creating a small surgical passage through the atrial septum (wall between the right and left atrium) through which a catheter can be directly fed. The puncture hole generally heals on its own following the procedure.