First Transcarotid TAVR Performed in Central Wisconsin

Jill Solin

Two Aspirus surgeons have successfully performed the first transcarotid access Transcatheter aortic valve replacements (TAVR) in Central Wisconsin.

Dr. Ronald Miles and Dr. John Johnkoski completed surgeries on two patients on September 12, 2019, at Aspirus Wausau Hospital (AWH).

TAVR is a minimally invasive procedure to replace the aortic valve in people with diseased valves. Until recently, the procedure was only done for patients that are too at risk for open-heart surgery.

TAVR is most commonly performed by delivering the valve through a catheter placed in a groin artery. However, there are still some patients for whom the groin artery is not an option because the artery is too small or too diseased. A transcarotid TAVR is performed with the surgeon using the carotid artery (artery in the neck) to gain access to the aortic valve. 

“Many approaches to a TAVR are very invasive and require lengthy recovery time,” says Aspirus Heart and Vascular Surgeon Dr. Ronald Miles. “The benefit of the transarotid approach is that it’s far less invasive than the other routes of access.”

That was the case for Roman Cavosi (pictured above) who is retired and living in Rhinelander. Roman’s doctor at the Aspirus Rhinelander Clinic ran some tests on his heart and decided that he needed to see Dr. Miles in Wausau. It was at that point that Roman was told he would need heart surgery.

Open heart surgery recovery time can often take months to return to normal. However, patients typically go home in one day after a TAVR procedure with minimal limitations and a total return to normal activities. It was determined that Roman’s arteries in his leg were too small, but he was a good candidate for the transcarotid approach.

“This is the only way I would have gone,” said Roman. “After talking with Dr. Miles, I decided to jump in and go for it.”

The cardiovascular team at Aspirus tapped into its full system of resources before deciding to move forward with the procedure. The team also brought in Dr. Keith Allen, a pioneer of this approach from MidAmerica Heart Institute in Kansas City, to brief the team and assist in the operating room during the first two procedures.

“This sets Aspirus apart because nobody else in our region is doing it,” said Dr. Miles. “One needs the skill set that involves the ability to do this. It’s a niche that we happen to have at Aspirus.”

Those skills were put into action as the Aspirus cardiovascular team collaborated to save two lives.

“We are very excited by the first two procedures, said Dr. Miles. “The patients are doing great and we as a team are already debriefing and are looking for this to become a back-up approach for more TAVR procedures.”

“I have no complaints. Everyone from the top to the bottom, they were very caring,” said Roman. “Everyone was always checking on me and making sure I was good. It’s been A-1 service.”

Aspirus has built one of the nation's best cardiovascular programs and Aspirus Wausau Hospital was selected as one of the Top 50 Cardiovascular Hospitals in the country by IBM Watson Health in 2018.

And the Aspirus cardiology team will look to build on that service as the outcomes from these procedures will help Aspirus sustain and grow vital resources that will continue to benefit the communities they serve.