Valvular Heart Disease:

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Oklahoma Heart Institute 1120 South Utica Avenue Tulsa, OK 74104 Valvular Heart Disease: Transcatheter AorticValve Replacement (TAVR) Transcatheter Mitral Valve Repair (TMVR) Oklahoma Heart Institute

1 Oklahoma Heart Institute 1120 South Utica Avenue Tulsa, OK Valvular Heart Disease: Transcatheter AorticValve Replacement (TAVR) Transcatheter Mitral Valve Repair (TMVR) Oklahoma Heart Institute Physicians Office Utica 1265 South Utica Avenue Suite 300 Tulsa, OK Oklahoma Heart Institute Physicians Office SouthPointe 9228 South Mingo Road Suite 200 Tulsa, OK OklahomaHeart.com Like us on Facebook OklahomaHeart.com

the left side of the heart receives this blood and pumps it into the rest of your body.

2 THE HEART How Does Your Heart Work? The heart is designed to pump blood through your body. The right side of your heart pumps blood through the lungs, where the blood picks up oxygen.the left side of the heart receives this blood and pumps it into the rest of your body. Chambers and Valves Each time your heart beats, it pumps blood through valves by contracting its chambers. These valves open in one direction allowing blood to flow forward. In between beats, the heart s chambers quickly relax, and its valves close, preventing blood from flowing backward. Valve & Structural Heart Center Team after completing the 100th TAVR procedure. NOTES 1 10

3 History of TAVR/TMVR at Oklahoma Heart Institute Performed First TAVR in Tulsa MAY 2, 2012 First Transapical TAVR in Tulsa NOVEMBER 13, 2012 First Transaortic TAVR in Tulsa JUNE 4, 2013 First Valve-In-Valve TAVR in OK NOVEMBER 26, 2013 First Commercial CoreValve TAVR in OK FEBRUARY 21, 2014 First TAVR without General Anesthesia in OK FEBRUARY 21, 2014 First Left Subclavian TAVR in OK MARCH 25, 2014 First TransCaval TAVR in OK SEPTEMBER 23, 2014 First Commercial MitraClip in OK NOVEMBER 18, HEART VALVES The Aortic Valve has three leaflets. It controls blood flow from the left ventricle to the aorta, sending blood to the rest of the body. The Pulmonary Valve has three leaflets. It controls blood flow from the right ventricle to the pulmonary artery, sending blood to the lungs to pick up oxygen. The Tricuspid Valve has three leaflets. It controls blood flow from the right atrium to the right ventricle. The Mitral Valve has two leaflets. It controls blood flow between the left atrium and left ventricle. Two Common Heart Valve Problems Stenosis: When your valve narrows and does not completely open because of problems like high cholesterol (a waxy fat), age, genetics (such as a birth defect) or build-up of calcium Regurgitation: When your valve does not fully close and allows blood to leak backwards through the valve 2

AORTIC STENOSIS What is Severe Aortic Stenosis?

aortic valve). This build-up of calcium on the leaflets impairs the aortic valve s ability to fully open and close.

Eventually, the heart s muscles weaken, increasing the patient s risk of heart failure and death. Severe aortic stenosis is a very serious problem.

4 AORTIC STENOSIS What is Severe Aortic Stenosis? Aortic stenosis is often caused by the build-up of calcium (mineral deposits) on the aortic valve s leaflets (flaps of tissue that open and close to regulate the one-way flow of blood through the aortic valve). This build-up of calcium on the leaflets impairs the aortic valve s ability to fully open and close. As a result, the narrowed valve allows less oxygen-rich blood to flow from the lungs to the brain and rest of the body, which may cause symptoms like severe shortness of breath and extreme fatigue. Eventually, the heart s muscles weaken, increasing the patient s risk of heart failure and death. Severe aortic stenosis is a very serious problem. Without treatment, half of the people who feel sick from this problem die within an average of two years. Cardiovascular Surgeon The physician who specializes in heart surgery, including the repair or replacement of heart valves. Paul Kempe, MD Dr. Kempe received his undergraduate degree in Chemistry at Abilene Christian University. He completed his medical degree at the University of Texas Southwestern Medical School in Dallas. His Internship and Residency were completed at Richland Memorial Hospital in Columbia, South Carolina. Dr. Kempe is board certified by the American Board of Thoracic Surgery. Michael Phillips, MD, FACC, FACS Dr. Phillips has been a Cardiovascular Thoracic Surgeon since Professional organizations of which he is a member include the Society of Thoracic Surgeons, American College of Cardiology, Society for Endovascular Surgery and American College of Surgeons. Dr. Michael Phillips is board certified in Surgery, and Cardiovascular and Thoracic Surgery. Valve Coordinator The nurse who acts as a resource to patients and their families throughout the entire treatment process. Georgianne C. Tokarchik, APRN-CNS Georgianne C. Tokarchik, APRN-CNS, received her Master s degree from the University of Oklahoma as an Acute Care Clinical Nurse Specialist after completing a Bachelor of Science degree in Nursing from The University of Tulsa. She began her career as a Registered Nurse with a primary focus in cardiology. Georgianne holds a national certification from the American Association of Critical Care Nursing as an Adult Health Clinical Nurse Specialist. Anesthesiologist The anesthesiologist is trained to provide sedation during surgical procedures. Critical Care Physicians and Nurses The critical care or intensive care unit in a hospital is a specialized area where you are closely monitored and treated following cardiovascular surgery. The critical care team manages your care during this time. 3 8

MEET THE TEAM If you plan to undergo TAVR or TMVR, you will be cared for by the Oklahoma Heart Institute team of cardiac medical specialists who are committed to ensuring your safety

Primary Care Physician The physician who may be the first to identify the symptoms of heart valve disease or other conditions that can cause heart valve disease or defects.

The cardiologist does not perform heart surgery but often performs diagnostic tests to identify the cause of heart problems and determine the course of treatment to manage heart disease.

If a cardiac surgeon determines that you are at high risk or too sick for open-heart surgery, Transcatheter Aortic Valve Replacement (TAVR) is a less invasive procedure.

TAVR is a state-of-the-art alternative to open-heart surgery. It is minimally invasive, requires less recovery time and is less painful.

Muhammad is a subspecialist in interventional cardiology with Oklahoma Heart Institute.

Muhammad serves as the Director of the Structural Heart Disease Program and Transcatheter Aortic Valve Replacement Programs at Oklahoma Heart Institute. Dr.

Leimbach is a specialist in interventional cardiology. He is Director of the Cardiac and Interventional Laboratories at Oklahoma Heart Institute Hospital and also is Chief of Cardiology.

5 MEET THE TEAM If you plan to undergo TAVR or TMVR, you will be cared for by the Oklahoma Heart Institute team of cardiac medical specialists who are committed to ensuring your safety and comfort before, during and after your procedure. Below you will find information describing different health care professionals you may meet during the course of your care. Primary Care Physician The physician who may be the first to identify the symptoms of heart valve disease or other conditions that can cause heart valve disease or defects. He or she may order special tests to confirm the diagnosis or refer you to the appropriate specialist. Cardiologist The physician who specializes in diseases of the heart. The cardiologist does not perform heart surgery but often performs diagnostic tests to identify the cause of heart problems and determine the course of treatment to manage heart disease. The cardiologist may prescribe medications and/or refer you to a cardiovascular surgeon. TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) What is Transcatheter Aortic Valve Replacement? If a cardiac surgeon determines that you are at high risk or too sick for open-heart surgery, Transcatheter Aortic Valve Replacement (TAVR) is a less invasive procedure. TAVR allows a new aortic valve to be inserted within your diseased aortic valve without opening your chest and while your heart is still beating. TAVR is a state-of-the-art alternative to open-heart surgery. It is minimally invasive, requires less recovery time and is less painful. Interventional Cardiologist A cardiologist who specializes in minimally-invasive, non-surgical methods of treating heart and vascular disease. Kamran Muhammad, MD, FACC, FSCAI Dr. Muhammad is a subspecialist in interventional cardiology with Oklahoma Heart Institute. With advanced training in structural heart disease intervention from the world-renowned Cleveland Clinic, Dr. Muhammad serves as the Director of the Structural Heart Disease Program and Transcatheter Aortic Valve Replacement Programs at Oklahoma Heart Institute. Dr. Muhammad led a team of OHI physicians in performing the first TAVR and TMVR in Tulsa and the region. Wayne N. Leimbach, Jr., MD, FACC, FSCAI, FCCP, FAHA, FACP Dr. Leimbach is a specialist in interventional cardiology. He is Director of the Cardiac and Interventional Laboratories at Oklahoma Heart Institute Hospital and also is Chief of Cardiology. Dr. Leimbach is Co-Founder of the Lipid and Wellness Clinic at Oklahoma Heart Institute. He is Director of the James D. Harvey Center for Cardiovascular Research at Hillcrest Medical Center, as well as Director of the Oklahoma Heart Research and Education Foundation. Transfemoral TAVR Procedure (TF-TAVR) A procedure that is approached through the femoral artery in your leg Treatment for patients with severe symptomatic aortic stenosis Approved for patients who are either too sick or are considered high-risk for traditional open-heart surgery 7 4

6 MITRAL REGURGITATION What is Mitral Valve Regurgitation? The mitral valve is the valve between the left atrium and left ventricle of your heart. In a normally functioning valve, blood flows in a single direction between the left atrium and left ventricle. When your mitral valve s two leaflets (or flaps) do not close properly, some blood flows backward through the valve back into the left atrium. This is called mitral regurgitation (MR). As a result, blood can t move through your heart or to the rest of your body as efficiently, making you feel tired or out of breath. Treatment of mitral regurgitation depends on how severe your condition is, whether it s getting worse and whether you have symptoms. Untreated, severe mitral regurgitation can cause heart failure or heart rhythm problems. NORMAL REGURGITATION TRANSCATHETER MITRAL VALVE REPAIR (TMVR) What is Transcatheter Mitral Valve Repair? If a cardiac surgeon determines you are too high risk for open-heart surgery, Transcatheter Mitral Valve Repair (TMVR) is a non-surgical and minimally-invasive alternative. TMVR allows for repair of the leaky mitral valve using one or more small clip-like devices to be placed on the mitral valve to decrease the leaking. This is done without opening your chest or stopping your heart. MitraClip MitraClip therapy is an approved treatment to repair your leaking mitral valve using an implanted clip. The MitraClip device is smaller than the size of a dime. About the Procedure First, a small incision will be made in your leg vein to deliver the clip to your heart. Your doctor will implant the clip in the best position to bring the mitral valve leaflets together to reduce the mitral regurgitation. Once the clip is in place, it will become a permanent part of your heart, allowing your mitral valve to close more tightly and reduce the backward flow of blood. 5 6

TAVR (Transcatheter Aortic Valve Replacement).

HEART & VASCULAR Your guide to TAVR (Transcatheter Aortic Valve Replacement). An alternative to open heart valve replacement surgery. For many years, the only way to treat a heart valve condition was through