Structural Heart/Valve Disease Program

• Heart Valve Disease (Valvular Heart Disease)
  • Aortic stenosis and regurgitation
  • Mitral stenosis and regurgitation
  • Tricuspid regurgitation
  • Pulmonary regurgitation
  • Paravalvular leak
• Stroke Risk Reduction for Atrial Fibrillation (Afib)
  • Percutaneous and surgical left atrial appendage closure
• Septal Defects ("hole in the heart")
  • Congenital/Present at Birth
    - Atrial septal defect (ASD)
    - Ventricular septal defects (VSD)
  • Patent foramen ovale (PFO) closure
• Heart Murmur

Inova is a national leader in minimally invasive repair techniques, including transcatheter aortic valve replacement (TAVR) procedures. Our comprehensive approach identifies the best treatment for each patient.

We offer:

• Outcomes exceeding the national average
• Clinical trials to expand the use of TAVR, including asymptomatic patients and bicuspid aortic valve patients
• A state-of-the-art hybrid operating room where cardiac surgeons, cardiologists and electrophysiologists operate together for fewer complications and shorter recovery
• Expedited referral-to-OR process
• Easily access - just 10 miles from downtown Washington, DC

TAVR revolutionized aortic stenosis treatment, offering a minimally invasive alternative to traditional open aortic valve replacement surgery. The transcatheter approach allows for early mobility, a much shorter length of stay and rapid recovery. Inova offers options for customizable heart valves including, the Evolut ™ PRO valve and Sapien 3 valve.

TAVR treatment options are available across all risk profiles, including patients with asymptomatic aortic stenosis.

Read more information about TAVR

Mitral valve regurgitation (MR) is a prevalent and often progressive disease affecting more than 4 million Americans. Due to the mitral valve's complex anatomic structure, only a small minority of patients with severe MR have undergone surgical valve repair or replacement. Technical advances now offer patients newer, less invasive options, including MitraClip® and Intrepid™ Transcatheter Mitral Valve Replacement (TMVR). Inova Schar Heart and Vascular’s surgeons and interventional cardiologists, who are among the most experienced in the region, evaluate potential candidates for these procedures.

Patients typically visit the valve clinic once or twice before their scheduled procedure to meet the valve team, including the interventional cardiologist and heart surgeon. They also complete cardiac imaging studies (TEE +/- cardiac CT) during their visits.

Post-procedure, patients return to the valve clinic once or twice for follow up, then return to their primary care provider or local cardiologist for ongoing care.

Intrepid™ Transcatheter Mitral Valve Replacement (TMVR)

Inova offers the Intrepid™ TMVR system, a minimally invasive alternative to open-heart surgical repair for select high surgical risk patients through the Apollo trial. This study evaluates the safety and efficacy of the TMVR System in patients with severe symptomatic mitral regurgitation who are either ineligible or at increased risk for conventional mitral valve surgery.

MitraClip®

The MitraClip® procedure is indicated for patients who are not candidates for surgical mitral valve replacement due to prohibitive risk. The device is placed using a minimally invasive catheter-based approach and real-time imaging. Patients generally are discharged home within three days.

Millions of Americans (approximately one in 30 people over the age of 65) suffer from tricuspid valve regurgitation (TR) caused by a leaky tricuspid valve. TR is challenging to treat, yet left untreated, can significantly interfere with patients' quality of life and ultimately result in heart failure and death. Medications can control symptoms such as swelling, but the only real option to repair the leaky valve has traditionally been open heart surgery. Unfortunately, that option is too risky for many patients with tricuspid regurgitation, who tend to be older and often have other health problems.

Clinical Trial for New, Transcatheter Tricuspid Valve Repair Procedure

Inova Schar Heart and Vascular is pleased to participate in the TRILUMINATE Pivotal Trial, a research trial studying the TriClip™ Tricuspid Valve Repair System in patients with severe tricuspid regurgitation who meet the criteria for transcatheter intervention.

The TriClip procedure repairs the tricuspid valve without the need for open-heart surgery. The device is delivered to the heart through the femoral vein in the leg and works by clipping together a portion of the tricuspid valve's leaflets to reduce the backflow of blood. This approach allows the heart to pump blood more efficiently, relieving TR symptoms and improving a person's quality of life

"There is a similar procedure for repairing leaks in the mitral valve," said Wayne Batchelor, MD, MHS, Director of Interventional Cardiology and Interventional Cardiology Research for Inova Schar Heart and Vascular. "But such an option hasn’t been available for the tricuspid valve. One reason for that is that the tricuspid valve has more leaflets, or flaps, making it more challenging to place the clips. Another is that its location makes it harder to get clear images of the valve and to place the clips in the right location. Thanks to new imaging techniques and new devices, we’re finally able to test a nonsurgical option for treating this disease."

Contact Us to Learn More About the TRILUMINATE Pivotal Trial

The WATCHMAN FLX™ left atrial appendage closure procedure offers stroke risk reduction in nonvalvular atrial fibrillation (AFib) patients who are not candidates for chronic anticoagulation medications (i.e., blood thinners) due to noncompliance, occupational restrictions, long-term bleeding or a strong preference not to take anticoagulants. Patients can be discharged home after placement of the device, which occurs in Inova's interventional lab, followed by an overnight stay. Most patients can permanently discontinue anticoagulation medications after 45 days.

Learn more about WATCHMAN FLX™ and meet the doctors who perform this procedure

We treat atrial septal defects (ASDs) and patent foramen ovales (PFOs), which are holes in the septum (wall of tissue) between the left and right upper chambers of the heart with very different causes.

• ASDs are abnormal openings between the two upper chambers of the heart that cause blood to leak from one chamber to the other. ASD holes are present at birth (congenital) and vary in size and severity.
• PFOs occur when a baby's foramen ovale doesn't close after birth. The foramen ovale is a hole/flap in the wall between the left and right atria of every human fetus that lets blood bypass the fetal lungs, which don't work in utero. The flap should close when newborns take their first breath and seal entirely within a few months. If it doesn't seal, blood can leak from the right atrium to the left. When that blood contains a clot, problems can occur.

Atrial Septal Defect (ASD) Catheter Repair
Inova cardiologists and cardiac surgeons offer specialized expertise in various techniques to resolve ASD, including minimally invasive catheter repair. They insert a small disk-like device into the groin by threading it through a catheter (thin, flexible tube). The device then expands across the atrial septal defect to permanently close the opening.

Patent Foramen Ovale (PFO) Catheter Repair
PFO catheter repair closes the patent foramen ovale (flap in the atrial septum wall). Our structural heart cardiologists insert a catheter with a closure device through the leg vein, up to the heart, where it is left to close up the flap. Clinical trials have shown that patients who have had a cryptogenic stroke and have a patent foramen ovale (PFO) can benefit from PFO closure.

• Clinical Trial with Amplatzer™ PFO Occluder
  Inova participates in a clinical trial using the Amplatzer™ PFO Occluder for PFO closure in patients who have failed conventional drug therapy and have recurrent cryptogenic strokes due to presumed paradoxical embolism (passage of a clot/thrombus from a vein to an artery) through a patent foramen ovale.

When artificial valves replace damaged heart valves, they can sometimes develop a leak (regurgitation or blood backing up into the pumping heart chamber). The most common cause of paravalvular leaks is an infection, but other factors such as the amount of calcium around the valve can also cause leaks. While small leaks may cause no symptoms, larger leaks can cause congestive heart failure, hemolysis, and a higher risk for future infections.

Inova’s specially trained interventional cardiologists perform transcatheter (minimally invasive/nonsurgical) PLV repair by inserting a catheter into a blood vessel in the groin area, advancing it through the blood vessels to the site of the leaking heart valve, and implementing one or more specialized closure devices to plug the leak.

Symptoms of Paravalvular Leak (PVL)/Valve Regurgitation

PVL symptoms may include shortness of breath, fatigue, a heart murmur, rapid or fluttering heartbeat, or swelling in the feet or ankles. Even if no symptoms are present, repair may prevent PLV from getting worse or relieve the workload on your heart.

At Inova, we were among the first five teams in the United States selected to use the Medtronic Harmony™ Transcatheter Pulmonary Valve (TPV) System as part of the relaunch in early 2023. This device is FDA-approved and designed specifically for severe pulmonary regurgitation.

The Harmony TPV uses a tiny wire frame, rather than a balloon. The structure is designed especially for pulmonary regurgitation and fits larger RVOTs. Our team at Inova has successfully implanted the Harmony TPV in three people with severe pulmonary regurgitation. They ranged in age from 16 to 60.

Who qualifies for TPV?

A cardiologist who is familiar with the TPV procedure can determine whether the Harmony TPV could treat your pulmonary regurgitation. To make that determination, we usually perform an MRI to check the function of your current pulmonary valve and the size of your right ventricle. If pulmonary valve replacement is indicated, we will order a CT scan to take measurements of your heart.

We send those measurements to Medtronic. They analyze the data and let us know if the Harmony TPV could work for you. With this process, we can be confident that the device is a good fit without using more invasive tests.