San Francisco VA shares experience opening TAVR program

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Sapien transcatheter aortic valve.
Source: Edwards Lifesciences

Installing a state-of-the-art hybrid cardiac cath lab and developing a successful transcatheter aortic valve replacement (TAVR) program are necessarily complex. The San Francisco Veterans Affairs (VA) Medical Center detailed its process in an article published online Jan. 14 in JAMA Surgery.

The process began in 2011, according to Kendrick A. Shunk, MD, PhD, from the Division of Cardiology at the San Francisco VA Medical Center in San Francisco, and colleagues. A proposal went to the VA Central office on Feb. 2, 2013. With its approval, the new hybrid space was open for business November 2013.

Leading up to that point, the VA went through an extensive process, reviewing and approving space for the building, creating and drilling the clinical team, and ensuring the space and the procedures complied with necessary codes. An assessment of patients under their care assured them that the volume requirements to meet TAVR standards were achieved.

TAVR simulations performed using cardiac cath lab and operating room teams were performed throughout January and February of 2013 with site visits April and August 2013 to make sure the VA was adequately prepared.

In the five months following program approval, they successfully performed 10 transfemoral TAVRs. Implantation was successful in all patients. No patients died either during operation or in the subsequent 30 days.

Further hybrid operating rooms are planned, contingent modifications to existing operating rooms.