Cardiothoracic Surgery

Team Approach Helps Most Frail Patients Undergo Heart Surgery

Team Approach Helps Most Frail Patients Undergo Heart Surgery
“This is the most significant innovation in cardiology and cardiac surgery in the past decade,” Dr. Comas says.

The condition sounds serious and it is: Aortic stenosis occurs when the valve between the heart and the aorta calcifies and becomes constricted, causing decreased blood flow to the entire body.

Healthy patients who need valve replacement traditionally undergo open- heart surgery to replace this valve either with a tissue or mechanical valve. However, this option is not available for fragile patients whose health has deteriorated or are considered high risk.

Since December 2011, those patients have had the option of the transcatheter aortic valve replacement (TAVR) procedure at HealthPark Medical Center.

This procedure is minimally invasive and involves threading a wire across the diseased aortic valve. The access to the heart is by a small incision in the groin or the chest wall, says cardiothoracic surgeon George Comas, MD. The new crimped valve is deployed over the wire at the position of the old valve. Once it is expanded with a balloon, it is held in place by the calcified annulus and replaces the old valve.

Dr. Comas is a part of the transcatheter valve team at HealthPark Medical Center. Cardiothoracic surgeon Brian Hummel, M.D., and cardiologists Murali Muppala, M.D., and Steven Priest, M.D., also are involved in every TAVR surgery.

This complex procedure is performed with two interventional cardiologists and two cardiothoracic surgeons working together. There are dedicated anesthesiologists, nurses, technicians, and perfusionists that are essential to making sure the case goes smoothly.

Prior to the advent of this procedure, high-risk patients had limited options, Dr. Comas says. The disease progresses and symptoms worsen. Patients would often die between 2 and 5 years of the onset of symptoms.

Patients who develop aortic stenosis are usually older than age 65. Edwards Lifesciences, the company that manufactures the TAVR valve, estimates that 7 percent of the United States population age 65 and older develop clinically significant aortic stenosis.

Aortic stenosis can occur from an abnormal valve present at birth, as a result of some childhood diseases like rheumatic fever or as part of the aging process. Over time, with wear and tear, the valve degenerates and calcifies or as it becomes stenotic (narrows), it limits the blood flow out of the heart. The heart has to work harder and consequently chest pain or pressure may develop as the demand outstrips the blood supply. Blood pressure to the brain is reduced and blood backs up into the lungs.

Patients may not know they have this abnormality until later in life, until they start to experience chest pain, light headedness and shortness of breath, Dr. Comas says. Many of our patients are octogenarians who have felt bad for years or felt that they aren t as active as they used to be.

The major signs that patients need to tune into include:

  • Chest pain or pressure
  • Shortness of breath
  • Dizziness

If someone starts having these symptoms, he or she needs to talk to their primary care physician and get a referral to a cardiologist, Dr. Comas says. Once that physician completes the necessary tests, we can take the steps to help. This is a wonderful new option for a number of patients.

This is the most significant innovation in cardiology and cardiac surgery in the past decade, Dr. Comas says. Following this minimally invasive procedure, patients recover quickly and feel much better remarkably soon , he says.

More information on TAVR can be found at or by calling the Structural Heart Program at HealthPark Medical Center 239-343-8836.

TAVR- The Next Big Thing


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George M. Comas, M.D.
Gulf Coast Cardiothoracic Surgeons
8010 Summerlin Lakes Drive
Suite 100
Fort Myers, FL 33907



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