The Evolution of Transcatheter Valve Therapy

By Dr. Peter M. Bittenbender, Interventional Cardiologist and Director of the Summa Health Structural Heart Valve Program, and Michelle Michel, MSN, APRN, Valve Program Coordinator
Thursday, September 5, 2019

Since inception of the Summa Health Structural Heart Valve Program in late 2014, our team has performed more than 500 transcatheter structural heart procedures, including aortic valvuloplasty, transcatheter aortic valve replacement (TAVR), aortic valve in valve replacement, transcatheter mitral valve repair (mitral clip), transcatheter mitral valve in valve replacement, and transcatheter ASD/PFO closure.

Dr. Peter M. Bittenbender

Michelle Michel, MSN, APRN

The most commonly performed procedure in our institution and around the country is transcatheter aortic valve replacement (TAVR). However, the methods in which the Summa Health heart valve team prepares and treats patients undergoing TAVR have changed significantly over the years, and reflect latest evidence and contemporary practice across the country and abroad.

Historically, TAVR patients were admitted to the hospital the evening prior to the procedure, prepared for cardiothoracic surgery, and given general anesthesia. Valve deployment was guided by a transesophageal echocardiogram (TEE) and all patients were monitored invasively with central venous access, an arterial line and a Foley catheter. The average length of stay was typically three to four days.

Today, patients are admitted the morning of the procedure and receive light sedation. Transthoracic echocardiography is now used instead of TEE; central lines, arterial lines and Foley catheters are omitted to remain less invasive; and most patients are discharged on POD 1. More than 95% of cases performed are transfemoral, although our program has expertise in alternate access TAVR (including transaortic, subclavian/axillary and transapical) should the anatomy warrant. Even with the changes and decreased length of stay, we have maintained excellent clinical outcomes.

TAVR In-Hospital Metric Summa
U.S. Registry
Mortality 0.7% 1.5%
Stroke 0.7% 1.8%
Procedure-Related Cardiac Event 0.7% 1.2%
Acute Kidney Injury 0% 0.7%
Vascular Complication 2.1% 3.7%
Moderate to Severe AI 0% 1.1%
Device Complications 0% 0.7%
Disabling Bleeding 0.7% 1.9%
Pacemaker Insertion 5.7% 9.4%
TAVR 30-Day Followup Summa
U.S. Registry
Mortality 2.1% 2.3%
Stroke 0.7% 2.2%
Vascular Access Complications 3.6% 4.1%
Permanent Pacemaker 7.6% 11%
Aortic Insufficiency 0% 0.6%

In fact, the Summa Health structural heart valve team was selected as one of six U.S. sites to participate in a program to fully optimize all components of our transfemoral TAVR program. As a result, our average post-procedure length of stay declined from 2.3 to 1.25 days (84% of patients are discharged on POD 1), ICU length of stay declined from 15.2 hours to 1.8 hours, and procedure time declined by 32 minutes — allowing for more procedures with the same resource allocation.

For more information about the Summa Health Structural Heart Valve Team or to make a referral, call our dedicated phone line at 844.241.8490.

To learn more about Summa Health Heart and Vascular Institute, visit