In a few months, Butler Health System will be able to offer an alternative to open heart surgery for certain high-risk patients.

The procedure is a transcatheter aortic valve replacement, or TAVR.

“We are very excited and looking forward to having this new technology available here,” said Dr. Hazem El-Khatib, cardiothoracic surgeon and medical director of cardiovascular operations at the hospital.

Patients who can receive this surgery are patients with severe aortic stenosis, where a valve is heavily calcified and not opening well. This often is discovered during examinations or when patients are experiencing symptoms such as fatigue and shortness of breath.

When the problem is considered severe, patients are considered candidates for procedures to fix it.

In traditional open heart surgery, the chest is opened, the heart is stopped and a faulty valve is replaced.

In TAVR, the valve — which is made of tissue — is delivered using a catheter through the groin or though a small incision on the tip of the heart.

“You do not have to stop the heart,” El-Khatib said.

The old valve is not removed. The new valve is inserted and blown up using a balloon.

“You just put this new one in and basically reopen the valve,” El-Khatib said.

TAVR is a lot less invasive than traditional open heart surgery. It also has a quicker recovery time and shorter operating time.

The procedure takes one to two hours. Patients on average have to stay in the hospital for two to four days and have one to two weeks of recovery at home.

With open heart surgery, patients stay in the hospital for five to seven days and have six to eight weeks of recovery at home.

El-Khatib said studies for the procedure were done in 2010 and 2011, and it came on the market in 2012.

“It's just in the last two to three years that it has been done on the national level,” El-Khatib said. “The programs have been expanding since then.”

To qualify for TAVR under original guidelines, patients need to be ineligible for open heart surgery or considered too high risk for open heart surgery.

“You could be too old, too frail, have multiple other medical conditions. That makes the risk of surgery too high,” El-Khatib said.

Since coming on to the market, he said the criteria for qualification have become a little more permissive.

“We expect that, over the next few years, even if you are moderate risk, you will probably qualify for that valve,” El-Khatib said.

If a patient is low risk — young and otherwise healthy — open heart surgery still is the way to go.

The TAVR procedure has not been done yet at BHS.

“We need a special operating room to do that,” El-Khatib said.

The room is called a hybrid room. This month, renovations on a heart operating room began to create this hybrid room. The renovations are expected to take about four months. El-Khatib said BHS hopes to start doing the procedure at the end of the summer.

The cost for the renovations and new equipment will be about $3 million. The hospital's annual Crystal Ball, which was held this month, helped raise funds for the renovations.

It is a traditional operating room that includes all the equipment present in cardiac catheterization labs. It can be used as a regular operating room when not doing TAVR procedures.

Although good for high-risk patients, TAVR is not a risk-free procedure.

One of the issues is paravalvular leak, where there is leaking around the new valve because it is not a perfect fit inside the heart. With new generation valves, this is less of an issue, he said.

Some risks include stroke, the valve cracking the heart and the valve damaging the artery.

“This procedure is not risk free,” El-Khatib said. “But you have to look at those risks and compare them to the risk of surgery in (eligible patients). Whichever is the lowest of the two risks is what you go for.”

Over the past few years, he said the procedure has advanced greatly. The risk of stroke during the procedure is much less now and the functioning of the replacement valve is greater.

El-Khatib said the only major advantage of open heart surgery is longevity.

“What is not known for the new valves ... is how well these valves are going to perform down the road,” El-Khatib said.

He said in the initial reporting the valves have been doing well in the short-term and medium-term.

When the procedure came onto the market, he said only a few centers — mainly large academic centers — were doing TAVRs.

“They have increased almost exponentially in the last two to three years,” El-Khatib said.

So, heart surgeons started having conversations with hospital administration about the possibility of doing TAVRs at Butler.

Last summer, the hospital decided to go forward with the project.

In this part of the state, only UPMC and Allegheny General are doing this procedure.

“We would probably be the third center in Western Pennsylvania to start that,” El-Khatib said. “It will help them get their care locally rather than having to travel down to the city.”

BHS performs about 300 to 350 open heart surgeries per year. El-Khatib said he would expect 20 to 40 patients getting the TAVR in its first year at BHS.