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Update from the Advanced Valve & Aortic Center

Low Risk TAVR Study Article Co-Authored by Ramlawi Published by New England Journal of Medicine

Basel Ramlawi, MD, chairman of the Heart & Vascular Center and director of the Advanced Valve & Aortic Center (AVAC) at Winchester Medical Center, co-authored an article on a study of transcatheter aortic valve replacement (TAVR) in low risk patients recently published by the New England Journal of Medicine.

The article, “Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients,” was published March 16, 2019, at The study was presented at the American College of Cardiology annual meeting in mid-March. Dr. Ramlawi presented subsequent related data at the American Association for Thoracic Surgery annual meeting in early May. This landmark publication shows that TAVR, and less invasive valve therapies in properly selected patients, is benefiting patients across all risk profiles with less pain, quicker recovery and improved clinical outcomes!

Valley Health’s AVAC was a leading study site among 64 institutions in the country participating in the Medtronic Evolut™ Low Risk Trial. The trial assessed the safety and efficacy of TAVR in patients with severe aortic stenosis who are at low risk for open-heart surgical aortic valve replacement. Initial enrollment in the trial is complete, but continued access is ongoing.

Low Risk Bicuspid Valve Study

Valley Health is also participating in Medtronic's TAVR Low Risk Bicuspid Valve Study, which Dr. Ramlawi is leading as the national co-Principal Investigator. He presented on the use of TAVR to treat severe aortic stenosis in patients with bicuspid aortic valve anatomy at the online Structural Heart Global Grand Rounds on April 9.

Mitral Valve Program

The AVAC team has completed initial procedures for the APOLLO transcatheter mitral valve replacement trial and the Neochord mitral valve repair trial. Valley Health’s mitral valve program includes complex surgical repair as well as the catheter-based MitraClip device. AVAC team members Dr. Ramlawi, Jeffrey Skiles, MD (echocardiography), AVAC Coordinator Debra Myers, DNP, Omar Ali, MD (interventional cardiology and AVAC co-director) and Claudia Viens, MD (cardiac anesthesia) authored an article on transcatheter mitral valve repair published in the Annuals of Cardiothoracic Surgery in November.


Ramlawi B, Skiles J, Myers D, Ali O, Viens C. Transcatheter mitral repair: MitraClip technique. Ann Cardiothorac Surg 2018;7(6):824-826. doi: 10.21037/acs.2018.10.14

Preventive Cardiology Clinic

  • Services for patients who may be at higher risk for heart disease because of family history of coronary artery disease, personal and family history of hyperlipidemia, genetic conditions and other factors
  • Assessment, screening, education and follow-up care
  • Coordination of advanced cardiac imaging such as cardiac CT, cardiac MRI and coronary artery calcium scoring

How to Refer: Call Winchester Cardiology and Vascular Medicine | Valley Health at 540-662-0306.

Heart Rhythm Disorders

Micra® Transcatheter Pacing System

  • Miniaturized leadless pacemaker for patients with bradycardia
  • Provides patients with the advanced pacing technology with reduced risk for infection or lead complications

Watchman™ Device

  • Permanent heart implant to occlude the left atrial appendage through an endovascular approach
  • Reduces the risk of stroke for patients with non-valvular atrial fibrillation and offers an alternative to the lifelong use of anticoagulation medications such as warfarin for patients with increased bleeding risk

Hybrid Ablation

  • Minimally invasive procedure that combines catheter ablation on inside of the atrial wall with minimally invasive surgery to access outside of the heart
  • Performed in Winchester Medical Center’s hybrid room by a cardiac surgeon and an electrophysiologist


  • Allows the electrophysiologist to treat the whole area of heart tissue that causes A-Fib at one time, reducing the procedure time compared to radiofrequency ablation

How to Refer: Call Winchester Cardiology and Vascular Medicine | Valley Health at 540-662-0306.

Heart Failure

Valley Health Advanced Heart Failure & Cardiomyopathy Center

  • Resources to help patients and their primary care provider or cardiologist manage advanced heart failure and cardiomyopathy
  • Outpatient evaluation and monitoring, outpatient IV infusion services and inpatient multidisciplinary rounding, along with patient education and support
  • Multidisciplinary heart failure team includes a fellowship-trained heart failure cardiologist, an experienced cardiology nurse practitioner, nurses, pharmacists, dietitians and other specialists

CardioMEMS™ Heart Failure System

  • Measures and monitors pulmonary artery pressure and heart rate in certain heart failure patients with the goal of reducing heart failure hospital admissions and improving quality of life
  • Small pressure-sensing device implanted directly into the pulmonary artery during cardiac catheterization procedure
  • Home electronics unit transmits the sensor’s data wirelessly to the patient’s doctor

How to Refer: Call the Advanced Heart Failure Center at 540-536-4555.

Aortic Aneurysm near the Kidneys

Fenestrated Endovascular Aortic Aneurysm Repair

  • Minimally invasive approach that allows vascular surgeons to repair an aortic aneurysm located near or around the branch arteries to the kidneys and other organs
  • Surgeon creates holes in the stent graft called fenestrations
  • Fenestrations allow blood to flow to the kidneys by the use of smaller grafts

How to Refer: Call Valley Health Vascular Surgeons at 540-536-6721.

Coronary Artery Disease

Minimally Invasive CABG

  • Minimally invasive coronary artery bypass grafting through small incisions to replace clogged arteries with a healthy vessel graft
  • Procedure does not require stopping the heart, and a heart-lung machine is not required; provides an alternative to standard open-heart bypass surgery (CABG) when bypassing one or two coronary arteries

How to Refer: Call Valley Health Cardiothoracic Surgeons at 540-536-6721.

Carotid Artery Disease

Trans-carotid Artery Revascularization (TCAR)

  • Helps reduce the risk of stroke during stenting to correct carotid artery stenosis
  • Tube placed directly into the carotid artery through a smaller incision than a typical carotid endarterectomy incision.
  • Tube connected to a system that directs blood flow away from the brain to protect against loosened plaque reaching the brain.
  • System filters the blood outside the body and returns the filtered blood through a second tube in the femoral vein.
  • After stent has been placed, blood flow is resumed in its normal direction

How to Refer: Call Valley Health Vascular Surgeons at 540-536-6721.

Varicose Veins


  • Treats patients with chronic venous insufficiency and symptomatic varicose veins
  • Minimally invasive/outpatient procedure
  • Specialty catheter which allows the surgeon to perform non-thermal venous ablation with no tumescent anesthesia required, resulting in a shorter procedure time, less pain and a quicker return to normal

How to Refer: Call Valley Health Vascular Surgeons at 540-536-6721.

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