New minimally invasive surgery program pays dividends for UMass Memorial

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By Emily Micucci

Brian Burke, a 76-year-old Warren resident, is well acquainted with the toll major surgery takes on the body.

Between a kidney transplant two years ago and an operation on his colon before that, Burke has spent more than four months of his life recovering in the hospital.

So when he learned he had a severely narrowed aortic valve that would require surgery, Burke knew he wanted to avoid open-heart surgery.

“I didn’t want full-blown surgery because I knew I’d be in tough shape,” Burke said.

Thanks to advances in minimally invasive surgery, Burke was offered an alternative by doctors at UMass Memorial Medical Center in Worcester.

New hope for high-risk patients

A minimally-invasive procedure, known as transcatheter aortic valve replacement (TAVR), was introduced at the hospital’s University Campus about a year ago. The procedure allows doctors to suture a replacement valve in patients like Burk, who suffer from sever aortic stenosis (which causes dangerous narrowing of the aortic valve) and are deemed to be at high risk for open-heart surgery, or cannot be operated on because of other health conditions.

This week, UMass Memorial provided a summary of TAVR results: Twenty patients have successfully undergone the procedure in the last six months; another four were scheduled to receive it this month.

One of the TAVR program leaders, Dr. Nikolaos Kakouros, an interventional cardiologist and director of UMass Memorial’s structural heart disease program, said these patients would have had a poor prognosis had they not received the procedure; about half of patients who present with severe aortic stenosis die within a year, Kakouros said.

“The only fix is to replace the valve,” Kakouros said.

Kakouros said it’s very gratifying to be able to offer the TAVR procedure as an option to high-risk patients such as Burke, who had done well since his kidney transplant and finished his follow-up care after the TAVR procedure in October.

According to Burke, the recovery was a cinch. The TAVR procedure is generally done through a small incision in the groin area, which allows doctors to enter the body with a wire and transport the replacement valve to the heart through a major artery.

The fatigue that used to plague Burke in the evenings, due to his heart disease, is gone, and he feels like a “new man.”

“As far as I’m concerned, I’m good for life,” said Burke, a retired engineer who lives with his daughter’s family.

A long-term investment?

UMass Memorial built a state-of-the-art facility to house the TAVR program in December 2013, at a time when UMass Memorial Health Care was planning to cuts other programs and downsize facilities. The TAVR site features state-of-the-art imaging equipment, which allows doctors to assess a patient’s internal anatomy before performing the TAVR procedure, and has the capacity to be used as a full-scale operating room, Kakouros said. The procedures take a lot of manpower, too — about 30 people per procedure, including doctors, nurses and technicians.

“We’re very lucky to be in a center here … that doesn’t look solely at the bottom line,” Kakouros said.

But long term, investing in minimally-invasive surgical procedures like TAVR will likely pay off.

For one thing, patients who receive the procedure are at low risk for readmission, compared to those who undergo open-heart surgery, Kakouros said. That’s important, because readmission rates are now linked to a penalty system on reimbursements from the federal Centers for Medicare and Medicaid (CMS).

And as the population ages, health care systems are taking a long view when they invest in services. Jay Cyr, senior vice president of surgical services at UMass Memorial Health Care, said the organization sees the potential for capturing a new set of patients through the TAVR program, as those who needed the procedure used to have to travel to Boston or Springfield.

Cyr said the program itself just about breaks even at this point, particularly because the valves themselves (which are made of pork and cow heart tissue) are very expensive. But as the market matures and prices come down, TAVR could be more profitable.

“Then the finances begin to line up more effectively,” Cyr said.

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