Over the past two decades, innovation in transcatheter therapies has expanded treatment options for patients with structural heart and valve disease and helped elevate minimally invasive solutions as a standard of care for many cardiac conditions.
Navigating complex treatment decisions requires multidisciplinary expertise in the latest technologies to improve patient outcomes. At the Structural Heart and Valve Center at NewYork-Presbyterian and Columbia, cardiothoracic surgeons, interventional cardiologists, interventional echocardiographers, and other specialists work alongside each other to provide comprehensive and cutting-edge treatment.
“The Heart Team is the cornerstone of quality. Columbia was one of the first groups in the world to recognize how powerful it is when cardiac surgery and cardiology work together for a common goal,” says Isaac George, M.D., co-director of the center and one of few surgeons who can perform both open cardiac surgery and percutaneous- and transcatheter-based procedures. “It is the reason we are able to achieve best-in-class outcomes, and it helps guide our research programs as well.”
The co-directors of the Structural Heart and Valve Center, from left: Dr. Isaac George, Dr. Tamim Nazif, and Dr. Torsten Vahl.
A Pioneering Approach to Care
Co-led by Dr. George and interventional cardiologists Tamim Nazif, M.D., and Torsten Vahl, M.D., the Structural Heart and Valve Center is one of the highest-volume programs in the country, performing over 1,000 transcatheter and surgical structural heart procedures annually. The team treats the full spectrum of valvular disease, including:
- Aortic stenosis
- Aortic regurgitation
- Mitral stenosis
- Mitral regurgitation
- Tricuspid stenosis
- Tricuspid regurgitation
- Congenital valve disease
- Bioprosthetic valve failure
Their expertise in treatment strategies span:
- Transcather aortic valve replacement (TAVR)
- Transcatheter mitral valve repair and replacement (TMVR)
- Transcatheter tricuspid valve repair and replacement (TTVR)
- Valve-in-valve bioprosthetic valve replacement
- Left atrial appendage closure
- Patent foramen ovale and atrial septal defect closure
NewYork-Presbyterian and Columbia’s history of leadership in the development of valve disease therapies means physicians have longstanding expertise in the most advanced technologies available. The center was co-founded by interventional cardiologist Martin Leon, M.D., and cardiac surgeon Craig Smith, M.D., who were leaders in the pivotal PARTNER clinical trials that established TAVR as a new treatment paradigm for aortic stenosis and helped it receive Food and Drug Administration approval in 2011.
Today, the center’s TAVR outcomes are among the best in the country for mortality, stroke, and pacemaker implantation rates, and physicians remain at the forefront of the development and testing of new devices for valve repair and replacement for patients across all risk categories.
“In addition to TAVR for aortic stenosis, our group has also led the ALIGN-AR trial, which has made TAVR available for patients with aortic regurgitation,” says Dr. Vahl. “Our experience as the first center in New York to implement this novel therapy has provided new treatment options for our high surgical-risk patients.”
Structural Heart and Valve Center physicians currently lead and participate in more than 30 active clinical trials, providing patients with early access to next-generation therapies. Examples of active trials include:
- Pivotal trials for novel transcatheter aortic valve replacement devices for both aortic stenosis and aortic regurgitation
- Feasibility and pivotal studies testing new transcatheter mitral valve replacement systems
- Feasibility and pivotal studies evaluating different types of transcatheter mitral valve repair
- Feasibility and pivotal studies for new transcatheter tricuspid valve replacement devices
- Trials for a novel cerebral embolic protection filter
- Studies on new large-bore vascular access closure devices
“Leadership in innovation and clinical research is central to our care mission,” says Dr. Nazif, who also serves as director of clinical research for Columbia Interventional Cardiovascular Care. “Through a broad clinical trial portfolio spanning early-feasibility studies to large-scale, pivotal evaluations of novel transcatheter heart valve therapies, we give patients early access to breakthrough therapies while simultaneously advancing the standard of care for the future."
A Structural Heart and Valve Center team that included, from left, Dr. Isaac George, Dr. Rebecca Hahn, Dr. Lauren Ranard, and Dr. Torsten Vahl recently completed the first U.S. implantation of a new transcatheter mitral valve replacement system as part of the CASSINI-US early feasibility study.
Setting Standards for Clinical Expertise
One of the hallmarks of the Structural Heart and Valve Center is its leadership in the evolution of structural heart disease care. For instance, historically for valvular disease, imagers were not directly involved in the administration of therapies, instead focusing on diagnosing disease and assessing post-procedural outcomes.
But many structural heart procedures are performed with the aid of transesophageal echocardiographic guidance, giving rise to the subspecialty of interventional echocardiography, with NewYork-Presbyterian and Columbia at the forefront. Rebecca Hahn, M.D., director of interventional echocardiography at the Structural Heart and Valve Center, is a trailblazer in the field as one of the first interventional echocardiographers and oversees imaging at the center throughout the patient journey, from initial diagnosis to procedural guidance and patient follow-up.
Mitral and tricuspid valve diseases also have very specific technical and anatomical challenges that can complicate treatment and require specialized expertise for optimal patient outcomes. The Mitral and Tricuspid Center, a part of the Structural Heart and Valve Center, was created to offer the most advanced transcatheter and surgical approaches to mitral and tricuspid valve replacement and repair, including transcatheter edge-to-edge repair, transcatheter valve replacement, complex valve reconstruction, and robotic valve surgery. In addition to Dr. George, Dr. Vahl, and Dr. Hahn, Arnar Geirsson, M.D., chief of cardiac surgery at NewYork-Presbyterian and Columbia and a global leader in mitral valve repair, provides unmatched experience in minimally invasive and robotic surgeries to help speed recovery for patients.
Says Dr. George, “Our mission at the Structural Heart and Valve Center is to treat every patient with the highest level of care using the latest technology and to lead the field into the future.”
