TAVR program continues growth, fosters integration

UNC Medical Center’s Structural Heart Team offers patients a chance at a more active life, promotes collaboration across the UNC Health Care system.

TAVR program continues growth, fosters integration click to enlarge Purcell Kimsey and Barry Cheek, MD
TAVR program continues growth, fosters integration click to enlarge UNC Medical Center's Structural Heart Team

By Jamie Williams, jamie.williams@unchealth.unc.edu

In May, World War II veteran Purcell Kimsey traveled to Chapel Hill for a transcatheter aortic valve replacement (TAVR) procedure. He brought his cardiologist with him.

Barry Cheek, MD, a cardiologist with High Point Regional Hospital has been treating Kimsey for three years. When he referred Kimsey to UNC Medical Center to undergo the TAVR procedure, he knew he and his practice partners Kurt Daniel, MD, and Joe Rossi, MD, would be able to coordinate closely with the TAVR team at UNC Medical Center to ensure Kimsey received the highest quality care. Daniel travelled from High Point Regional to Chapel Hill and assisted with the surgery, and the physicians’ constant communication ensured that Kimsey’s follow-up appointments could occur in High Point.

“The fact that we can have this collaboration and provide continuity of care to our patients is an incredible asset,” Cheek said.

In addition to treating Kimsey, Cheek said he has known the Kimsey family for several years through the High Point church they both attend.

John Vavalle, MD, assistant professor of cardiology, and Tommy Caranasos, MD, assistant professor of surgery, both co-directors of the UNC TAVR program, said the collaboration between physicians from UNC Medical Center and High Point Regional is representative of the integrated network that UNC Health Care has established across North Carolina to provide the highest level of care for patients.

“This patient’s family was comforted by the fact that someone who they know and trust was there to assist with the surgery,” Vavalle said. “That’s a level of service that I don’t think is available a lot of other places.”

“The collaborative relationship we’ve fostered  with High Point Regional and other practices across the state is really representative of the care that we aim to provide here at UNC for all patients in North Carolina,“ Caranasos said.

Kimsey’s granddaughter, Kimsey Parker, was reassured by the amount of care her grandfather received.

“The commitment was heartwarming, and honestly a surprise,” Parker said. “I knew that we had great people taking care of him.”

In addition to providing benefits to patients, the partnership is also beneficial for High Point Regional and its physicians.

“There are many procedures that are now being performed in academic medical centers that in the future may be more accessible in a larger community hospital like High Point Regional,” Daniel said. “So I want to be there to learn; I want to be able to collaborate and be involved. That’s a great advantage for us and it provides important continuity for our patients.”

The first TAVR procedure was performed at UNC Medical Center in late 2014. Now, Vavalle & Caranasos expect the number of cases in year two of the program to triple. Much of that increase can be attributed to great patient outcomes, coupled with the work done to establish relationships with cardiologists across North Carolina.

“In the first year, I think the natural instinct is for people to sit back, watch, and really make sure we know what we’re doing,” Vavalle said. “Now, we can get out, meet with cardiologists across the state, and show them our results.”

TAVR provides a treatment option for aortic valve replacement for many patients who previously had no other options or were considered too high-risk for conventional open heart surgery. With TAVR, physicians have the ability to provide aortic valve replacement via minimally invasive approaches, providing outcomes that are just as good as, and sometimes better than, surgical valve replacements.

The UNC program has pioneered a number of innovations aimed at expanding the availability of TAVR to more patients who may not have been eligible for the procedure before. The team has introduced the suprasternal TAVR approach, a point of differentiation from other TAVR programs. The team has also participated in the rollout of a next-generation valve that can be repositioned, helping to ensure proper placement.

The team is able to offer the procedure to patients like Kimsey, who at 95, is the oldest they have treated.

“This procedure is all about improving the quality of life for these patients,” said Cassie Ramm, AGNP-C, Structural Heart Disease Nurse Practitioner. “Our patients are at a point with their symptoms where they really aren’t able to get outside, aren’t able to visit their families. Many say they’ve lost their independence. We are able to give them that back.”

Even at 95, Kimsey shows no signs of slowing down. The lifelong High Point resident is a former Golden Gloves champion boxer and Navy veteran. He’s had many successful business ventures in High Point and even had a hand in founding Camp Cheerio, a summer camp in the North Carolina Mountains.

Following his procedure he was excited to pursue one of his principle hobbies, painting, while also spending the summer traveling to the beach with his children and grandchildren.

These stories are becoming familiar to the UNC Structural Heart Team.

“We’ve recently been seeing our first group of patients returning for their 12-month checkup, and these are people who have regained their ability to get out and live their lives,” Vavalle said. “I see a lot of vacation pictures.”

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