Henry Ford Hospital site of first TAVR via transcaval route

Physicians at the Henry Ford Hospital in Detroit have created a new route for transcatheter aortic valve replacement called transcaval and have treated the first patient with that approach.

The procedure was performed on a 79-year-old patient, Viola Waller, on July 3 after an aortic valve that had previously been implanted surgically was failing. She was transferred from northern Michigan to Detroit where it became clear no other access route would work.

“I knew of an experimental technique that had not yet been done in humans, and I had a patient with no other options who was failing rapidly,” William W. O'Neill, MD, medical director of the Center for Structural Heart Disease at Henry Ford Hospital, said in a press release.

William W. O'Neill

The transcaval approach that was performed, according to the release, involves placing a guidewire through a vein in a leg, and passing it from the main vein in the body into the abdominal aorta. The openings of the vein and artery are then widened by gradual dilation to the point of allowing a catheter to connect them and continue to the heart where a transcatheter valve is implanted. As the catheter is removed, plugs are inserted in the artery and vein to close the holes made for the temporary connection.

“Since all traditional options were not feasible, our multispecialty team felt the new technique could be the answer for this patient,” Adam Greenbaum, MD, director of the Cardiac Catheterization Lab at Henry Ford Hospital and leader of the team, said in the release. “She could not have open-heart surgery, and her condition was deteriorating daily.”

The transcaval access was performed with Robert Lederman, MD, an interventional cardiologist and senior investigator at the NIH who developed the technique in pigs, observing and sharing insights.

As a result of the procedure, Waller has made a remarkable recovery and has returned to her home in northern Michigan, according to the release.

“The success of this new procedure may open a new route for transcatheter valve replacement,” O'Neill said, adding that he estimates this new procedure could help 25,000 to 50,000 patients a year in the US alone.