Kendra Grubb and Structural Heart Center Associates Perform Live Cases for TVT 2019

August 2019

The Emory Structural Heart and Valve Center was one of only six stateside centers to perform live case demonstrations for the 12th Annual TVT (transcatheter valve therapy) Structural Heart Summit in Chicago. The physician team for the procedures included Kendra Grubb, MD, surgical director of the Structural Heart and Valve Center; Vasilis Babaliaros, MD, and Adam B. Greenbaum, MD, co-directors of the center; and Robert J. Lederman, MD, senior investigator for the National Heart Lung and Blood Institute (NHLBI), National Institutes of Health.

Drs. Grubb, Babaliaros, and Greenbaum are working with Dr. Lederman in NHLBI's Structural Heart Intervention Network, an evolving new consortium of leading institutions participating in clinical studies to help advance minimally invasive treatment options for structural heart disease (abnormalities of the heart's valves and chambers). Network members agree to work collaboratively to create new treatments for structural heart disease and introduce new treatments into clinical practice. The Emory Structural Heart and Valve Center is the network's inaugural member.

The TVT Structural Summits are sponsored by the Cardiovascular Research Foundation, and are designed to provide practicing physicians and healthcare staff with up-to-date information on the best clinical practices, latest research, and newest methods and technologies in the management of valvular and structural heart diseases, including in-depth coverage of less invasive transcatheter devices currently in clinical use or under investigation.

Drs. Grubb, Babaliaros, Greenbaum, and Lederman performed three procedures. The first was a transcatheter mitral valve replacement surgery that incorporated the new LAMPOON approach, a technique developed by an NHLBI and Emory team that makes an intentional laceration of the anterior mitral leaflet to prevent left ventricular outflow tract obstruction during surgery.

The second was a transcatheter aortic valve replacement (TAVR) procedure to replace a narrowed, failed surgical aortic valve. The surgery involved an NHLBI-developed method called BASILICA, which splits large valve leaflets so that they cannot block the flow of blood to the coronary arteries when the replacement valve begins functioning.

For the third surgery, the team treated a failing mitral valve replacement in a patient at high risk for complications related to reoperation. After placing a balloon expandable valve within the failed surgical valve, the team performed bioprosthetic valve fracture (BVF), a technique where the surgical sewing ring of the replacement valve is fractured with the high-pressure inflation of a balloon that has been threaded into position through a catheter, allowing the valve to expand to a more optimal size.

"The team functioned like a well-oiled machine for all three procedures," says Dr. Grubb. "We have all worked at the cutting edge of structural heart treatments for some time. Dr. Babaliaros was on the first surgical team to perform TAVR in Georgia and co-founded the Emory Structural Heart & Valve Center in 2006, Dr. Greenbaum co-directed the Center for Structural Heart Disease at Henry Ford Heart and Vascular Institute for 19 years and worked on BASILICA and LAMPOON, Dr. Lederman was part of the team that developed BASILICA and led a multicenter trial of transcaval TAVR, and I was heavily involved in studies of TAVR, MitraClip percutaneous therapy, and other cardiac technologies as the director of minimally invasive cardiac surgery at the University of Louisville before coming to Emory in 2018. We've crossed paths and collaborated throughout the years, so actually doing surgeries together feels very natural."

The Emory Structural Heart & Valve Center is a highly-specialized, multidisciplinary, comprehensive institution for all types of cardiac valve structural treatments including advanced imaging modalities, complex interventional and transcatheter approaches, as well as innovative and robotic surgical options. The center offers full-service locations at Emory University Hospital, Emory University Hospital Midtown, and Emory Saint Joseph's Hospital.