Transcatheter Aortic Valve Replacement as Good as Open Surgery, According to PARTNER Results

by Columbia Surgery on April 4, 2011

Craig R. Smith, MD, FACS

Craig R. Smith, MD, FACS

Approximately 300,000 patients in the United States have aortic stenosis (narrowing of the aortic heart valve), and about one third of these patients are too sick or too old to undergo surgical replacement. Under the leadership of NewYork-Presbyterian Hospital’s Division of Cardiothoracic Surgery, Transcatheter aortic valve replacement (TAVR) has been under study as a less invasive alternative for these patients.

According to to the most recent results of the landmark PARTNER study, TAVR is as good as open surgery in terms of long-term survival. Craig R. Smith, MD, Principal Investigator of the PARTNER study, presented long-awaited results of cohort A to the American College of Cardiology 2011 Scientific Summit in New Orleans April 3, 2011. This arm of the study compared long-term outcomes of traditional aortic valve replacement with the catheter-based method of replacing the aortic valve.

The study found the two methods equal in terms of long term survival. Patients who underwent transcatheter aortic valve replacement were at higher risk of stroke and vascular complications, while those undergoing open surgery were at greater risk of major bleeding.

Results of the first phase of the PARTNER trial, cohort B, were presented in December 2010. This phase found that compared with medical therapy (including balloon valvuloplasty), patients who were too sick or too old for surgery had a 20% improvement in survival after one year with transcatheter aortic valve replacement. In addition to living longer, patients also felt much better and experienced fewer hospitalizations.

Edwards SAPIEN transcatheter heart valve

Edwards SAPIEN transcatheter heart valve

The pivotal results from both cohorts of the PARTNER trial mean that patients with aortic disease now have a new therapeutic option that works exceedingly well. Craig R. Smith, MD, who presented the newest results at a special showcase session at the ACC summit, said in a statement that transcatheter aortic valve replacement “is the most exciting new treatment for aortic stenosis in the past two to three decades.”

At this time, transcatheter aortic valves are investigational devices in the US. Already approved and on the market in other countries, it is expected that TAVR may gain FDA approval as early as late 2011, at least for patients ineligible for surgery.

Dr. Smith is Chairman, Department of Surgery, Columbia University College of Physicians and Surgeons; Chief, Division of Cardiothoracic Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center; and Surgeon-in-Chief, NewYork-Presbyterian Hospital/Columbia University Medical Center/ Vivian and Seymour Milstein Family Heart Center. Other PARTNER investigators at NewYork-Presbyterian Hospital include Martin Leon, MD, Jeffrey Moses, MD, Susheel Kodali, MD, and Mathew Williams, MD.

Related Link:
New England Journal of Medicine: Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery

{ 58 comments… read them below or add one }

George Werfelman March 15, 2012 at 9:27 pm

Dr Smith, My uncle Robert Werfelman has congestive heart failure and his cardiologist Dr.Robert Pintauro has informed him of the need for aortic valve replacement surgery. At present the procedure being prescribed is standard surgery. My uncle has a physical handicap and is also diabetic. As I read more about the new procedures being offered I am encouraged that it would be beneficial for him. His next appointment with Dr. Pintauro is soon. Dr. Pintauro strongly endorses your hospital and is referring my uncle to a surgeon at Columbia Pres. Would it be acceptable to ask Dr. Pintauro to refer us to you? thank you.

Columbia Surgery March 16, 2012 at 1:23 pm

Mr. Werfelman:

Thank you for your comment.

I am going to forward your message to Dr. Smith’s office and one of us will be in touch with you. shortly.

If you or Dr. Pintauro would like to get in touch with us before then, please feel free t0 contact Dr. Smith’s office directly or leave another message on this blog. The phone number for Dr. Smith’s office is 212-305-8312. Additional contact information for Dr. Smith’s office can be found here: http://asp.cumc.columbia.edu/facdb/profile_list.asp?uni=crs2&DepAffil=Surgery.

Best wishes to your uncle.

David April 15, 2012 at 4:51 pm

My 86 y.o. mother recently died of obstructive sleep apnea, diastolic congestive heart failure, acute renal failure (25% function retained) and severe pulmonary HTN. I am wondering if TAV could have saved her, even up until shortly before her death.

Columbia Surgery April 16, 2012 at 6:41 pm

David:

I am so sorry to hear about the loss of your mother.

Dr. Smith would be the best person to answer your question. So I am going to pass this on to him. As soon as he gets back to me, I will post his reply and email you back.

Columbia Surgery April 17, 2012 at 11:42 am

David:

As you know it’s difficult to diagnose someone’s health condition over the Internet. Yet, the normal process that takes place during an in-person health assessment involves making sure that there is a certain amount of recoverable heart function. If there is, the surgeon would then assess the benefits of relieving the aortic stenosis against the risk associated with the TAVR procedure.

In the most basic of terms, the heart must have a certain level of health for the procedure to make a difference and there should be a likely possibility of recovery.

I hope this information helps.

David April 18, 2012 at 6:19 pm

Thank you for your reply, Dr. Smith. My mother passed away last Nov. at a teaching hospital in Westchester near NYC. At least 1 cardiologist with privileges at Cornell Weill stopped by to look at her.
Can I assume that the doctors at such an institution at that point in time were aware of TAVR and probably considered it in their assessment?
I fear she lost a chance to be saved because local doctors didn’t know TAVR existed and wonder if I could have saved her by taking her to NY Presbyterian instead.
Oddly, her heart was found to be in good shape at that same hospital just 2 months earlier.

Columbia Surgery April 23, 2012 at 12:40 am

David:

The TAVR procedure is well-known by doctors in both metropolitan and community-based centers and is considered in most assessments.

I hope this helps and if you have any further questions, please feel free to write us back.

David April 23, 2012 at 12:03 pm

I would just like to thank you for so kindly taking the time to reply. Your answer will help me put my mind at rest.

robin messina May 7, 2012 at 9:39 pm

My 81 year old father was diagnosed with aortic stenosis and is being referred to a specialist to determine if he can be sucessfully treated with this new proceedure. He is a strong man, 6 foot one and 292 lbs. , still works 3 (8) hour days per week. He takes warafin, fluid pills, singular and a nebulizer for breathing, high blood pressure med and diabetes….all managed and currently stable. We are told if he does not have the valve repaired he will eventually die from this. We lost our mother in Sept 2011 and want to do whatever we can to prevent the loss of our father.

Columbia Surgery May 8, 2012 at 3:31 pm

Robin:

Please give our office a call at 201-346-7001 or email us at info@columbiasurgery.org. Based on some additional information, we’ll be able to give you the name of a doctor who will be able to treat your father.

If you need anything else, please do not hesitate to ask.

Marisol P May 15, 2012 at 1:10 am

Hello Dr Smith
My father is 71 years old and he is scheduled for aorta and valve replacement. I feel he should have the surgery at New York Presbyterian. I read about the Ravi and is he a candidate for this surgery. I want the best for him,but need some guidance in this situation

Columbia Surgery May 15, 2012 at 7:34 pm

Marisol:

Thank you for your comment.

The best way to have your question answered and to discuss this would be to call Dr. Smith’s office directly at 212-305-8312. I will forward this message to him so he is aware of your message.

If I can be of any further assistance please leave another message.

michael m May 31, 2012 at 6:56 pm

dr smith, my father is 84 years old. he had quad by-pass and bi-vale replaced with a pig valve in 2002. he lives in upstate new york. recently struggling from shortness in breath, fluid on lungs. went in for a cardiologist appt and discover a tear in his replaced aortic valve via ECHO, TEE and Cath. we flew him to houston to see his surgeon and cardiologist. they believe he is an ideal candidate for the Edwards Sapien or Core proceedure. can you tell me how many valve in valve have been done in the US. risk of stroke greater? how long valve would last and how difficult it is to get into your team if his cardiologist recommends him to you.

Columbia Surgery May 31, 2012 at 7:34 pm

Michael:

I will forward your question to Dr. Smith. As soon as I hear back from him I will respond.

Thanks for your questions and best wishes to your father.

Columbia Surgery June 1, 2012 at 8:28 pm

Michael:

I received the following reply from Dr. Smith:

“Valve-in-valve is highly experimental, but might be appropriate and available for your father. It depends somewhat on the size of his valve and other technical details. Your father could be evaluate at Columbia if he’s interested. We’ve done quite a few valve-in-valve procedures under protocol. It’s important to recognize that conventional reoperation might also be a reasonable option. Evaluation can be arranged through my office.”

You can contact Dr. Smith’s office by calling 212-305-8312. If I can be of further assistant, please let feel free to leave another message.

Laura Wilson Williams June 2, 2012 at 7:57 pm

My 77 yo mother (Martha Wilson) was accepted today by your team as a candidate for the TAVI. My father and siblings and I are extremely hopeful and grateful for this surgery being a possibility for her to continue enjoying a quality of life with us!

Blessings to the hands of her team of professionals @ CUMC!

PS~ We presume we will receive detailed post operative plans and instructions (?), to be able to plan accordingly for maintaining her care

Columbia Surgery June 3, 2012 at 10:26 pm

Thanks for sharing you story with us Laura. I assure you that your mother will receive the best care possible along with the information you need to take care of her once she is at home.

If you need anything, before then, please feel free to contact anyone on our team.

Lou Skubic June 15, 2012 at 9:24 pm

I have been diagnosed w/ aortic stenosis at the Cleve Clinic. Due to my inherited condition .”.HHT”..(Osler-Weber-Rendu), every precaution is being taken to avoid any hemorrhaging during the procedure of “replacing” the valve.” I just returned from a Clinic appointment (fortunately I live w/in an hr. drive”) w/my Cardio. The “valve-in-a-valve” procedure was not discussed, and I just discovered this procedure while scanning the web site. How can I determine if I am a candidate, and to your knowledge, does the Clinic consider this procedure?
Thanks for your response.

Lou Skubic

Columbia Surgery June 17, 2012 at 10:51 pm

Hi Lou:

I am going to pass your message on to see which of our doctors would be the best to answer your question. As soon as I hear back, I will reply with another comment.

Just in case you would rather noy wait for my reply, you can also call 855-CUSURGE our referral line and they’ll give you the name of a doctor whom you can contact directly.

Columbia Surgery June 18, 2012 at 1:28 pm

Lou:

The person who you want to speak with is Dr. Mathew Williams. His details are here: http://asp.cumc.columbia.edu/facdb/profile_list.asp?uni=mw365&DepAffil=Surgery

I will forward a message to his office and you are more than welcome to call him directly at 212-305-9320. His assistant’s name is Lydia.

If you need anything else, please feel free to leave me another message.

Dawn Rice June 28, 2012 at 12:58 pm

My father is just about 86 yo. He has diabetes, HBP, clotting issues and low kidney function. He recently was hospitalized with a large build-up of fluid in his lungs, low oxygen, shortness of breath, etc. He was diagnosed with aortic stenosis with calcification and was told he would not handle open heart surgery well. A teaching hospital near him in Illinois did a full evaluation and said he was “too healty” for TAVR – he was above a rating of 4. He is again building up fluid, getting short of breath, his legs are weak and now he is having intermittent sharp pains in the left of his heart. Why would he not qualify for TAVR if he is failing again?

Columbia Surgery June 28, 2012 at 3:37 pm

Dawn:

I will run your question past our TAVR surgeon Dr. Mathew R. Williams and then let you know what he says. In the unlikely event that you do not hear back from me, you can also call Dr. Williams’s office at 212-305-9320.

Dr. Williams’s profile on our site: http://asp.cumc.columbia.edu/facdb/profile_list.asp?uni=mw365&DepAffil=Surgery

Susan Carmody July 8, 2012 at 6:45 pm

My mom is 83 and has been told by her dr. that she needs a valve replacement. I recently read an article in the Florida best in care magazine about TAVR and I am wondering if she would be a good candidate for this procedure. She did have triple-by-pass surgery back in 2005 and has been healthy up until this year. She has had some fluid build up in her legs and shortness of breath. Her heart has no blockages and her health otherwise seems to be good. I would appreciate it if you could refer me to the right person to discuss this option with me.
Thank you for your response.

Columbia Surgery July 9, 2012 at 11:32 pm

Susan:

You’ll want to speak with is Dr. Mathew R. Williams. You can reach his office by calling 212-305-9320. I will send Dr. Williams an email with the information you provided above so he’ll have that when you call.

Here is Dr. Williams’s profile if you would like any additional information on his background: http://asp.cumc.columbia.edu/facdb/profile_list.asp?uni=mw365&DepAffil=Surgery

If you need anything else, please feel free to leave another message.

mary wilson July 17, 2012 at 8:26 pm

My father is 89 and has been followed for several years by his cardiologist for aortic valve problems. Within the last few months, he has now become short of breath,experiencing dizziness at times and is always tired. His general practitioner has mentioned to us that we should look into TAVR,as he felt that he would greatly benifit from this. His cardiologist onthe other had believes in the more “old fashioned” approach. As a RN at MCHONY, I know what your departments reputation is. I would appreciate any guidance you can give me Thanks.

Columbia Surgery July 18, 2012 at 9:14 am

Mary:

I am going to pass your comment and email address onto Dr. Mathew Williams’s office. He would be the best person to answer your questions.

In the unlikely event that you do not hear from him, his office phone number is 212-305-9320. His assistant’s name is Lydia Nieves.

Thanks.

Randee Bloch August 20, 2012 at 4:20 pm

My soon to be 93 year old mother, in otherwise good health, had been diagnosed several years ago with aortic valve stenosis. She did not want surgery, but her NJ based cardiologist has recommended the TAVR procedure as her stenosis is now severe-critical. She lives independently, drives and plays cards with friends.
What is the risk factor as her quality of life is quite good and we are concerned about subjecting her to a procedure that may alter her life.
thank you,
Randee Bloch

Columbia Surgery August 21, 2012 at 10:14 am

Randee:

I have forwarded your message to Dr. Smith. As soon as I hear back from him, I will respond with his answer.

You can also contact Dr. Smith’s office by calling 212-305-8312. Thank you for your comment and best wishes to your mother.

Columbia Surgery August 22, 2012 at 9:57 am

I have received the following response from Dr. Smith:

It is difficult to be very specific without seeing your mother, which could be easily arranged. Some 93-year-old women face surprisingly low risk with conventional open heart aortic valve replacement (AVR), but not all, and every available option is worth considering. From your description, my guess is that your mother would qualify for the ongoing randomized clinical trial comparing conventional open heart AVR with transcatheter AVR, a procedure that avoids open heart surgery. If your mother is becoming symptomatic, it is time to consider her options for extending length of life and quality of life. She can be evaluated through my office, through our Valve Center, or a combination of both. Call my office (212-305-8312) and speak to Angie or Dana.

If you need anything else, please feel free to leave me another message.

fred reiss September 5, 2012 at 11:00 am

if my veins are small can the valve be inserted another way?

Columbia Surgery September 5, 2012 at 5:21 pm

Fred:

Thank you for your inquiry. I have forwarded your question to Dr. Smith and received the following response:

The device is inserted through the arterial system, not the venous system, but the question is still a good one. If a patient’s arteries are too small for the device, it can but introduced into the heart directly through the tip of the left ventricle (the pumping chamber to the body, that has the aortic valve at its exit point into the aorta). It can also be introduced through the aorta. Both of these alternatives will require an incision in the chest.

I hope this information helps. Please let me know if you have any further questions. Best wishes.

David September 10, 2012 at 1:17 pm

Is TAVR used in emergency conditions, e.g., could an elderly person with severe SOB only a week or 2 from death from CHF possibly be saved?

Columbia Surgery September 10, 2012 at 1:19 pm

David:

Dr. Smith said that TAVR could conceivably be used in that setting, but very unlikely. It often takes longer that two weeks to complete an evaluation, a patient that sick may not tolerate the necessary tests, and someone that close to death may not benefit.

Craig September 15, 2012 at 12:37 pm

Dr.,
My angel/wife is 41 years old and currently scheduled for this thursday for open heart surgery at Mayo in Rochester for replacement of pulmonary and aortic valves in addition to repairing stenotic pulmonary arteries and addressing tachycardia issue. We have to decide between mechanical valves which involve taking cumadin for life which would not be good for such an extended period of time but may insure that she wouldnt have to have any additional procedures, Or tissue valves (which would need addressing/replacing again 15-20 years down the road). My wife was born with tetrology of fallot and has had shunt procedure at 3, open heart surgery at 10 to repair the hole and open heart surgery again in 1996 for pulmonary valve installed with tissue valve and aortic valve repaired for leak. We are leaning towards the decision to go with the tissue valves to avoid cumadin and hope for more advancements in valve work through catheterization for future attention(Melody/TAVR). While we feel confident in the hands of the medical team here, we are looking for guidance in helping us make this decision.
Your response is greatly appreciated
Thank you

Columbia Surgery September 17, 2012 at 9:51 am

Craig:

Thank you for reaching out to us for further information. I have forwarded your comment to Dr. Smith. As soon as I hear back from him, I will respond with his answer. You may also contact his office at 212-305-8312.

Best wishes to you and your wife.

Columbia Surgery September 18, 2012 at 6:08 pm

Craig,

I received the following response from Dr. Smith:

This is a very complex situation in which it would be irresponsible to offer much advice at this distance, even with the excellent summary provided. You are in excellent hands at Mayo, and this is always a highly individualized decision. If the MD’s at Mayo are recommending one choice or the other, I would follow their advice. Speaking in broad generalities that may not apply here, the case for mechanical valves gets a little stronger with each reoperation, despite everyone’s understandable aversion to Coumadin.

I hope this information helps. We wish your wife all the best in her operation.

David November 13, 2012 at 4:40 pm

Can TAVR be performed on the non-ambulatory?

Columbia Surgery November 13, 2012 at 4:53 pm

David:

Dr. Smith replied to your question.

“Yes, depending on exactly what is meant by non-ambulatory. This person could be assessed by the valve team to help sort that out.”

Just to flush this out, being non-ambulatory in itself does not disqualify someone from having TAVR. But the seriousness of the condition as well as other health factors need to be considered as a whole.

lynne heinle December 19, 2012 at 8:24 am

My 33 year old son needs an aorta valve replacement. He is otherwise healthy. He is a grad student and doesn’t want to miss a lot of school. Because he is young and healthy otherwise would you still do the TAVR? We live in NJ and could easily come to Columbia. Thank you.

Columbia Surgery December 19, 2012 at 9:58 am

Lynne,

Thank you for your inquiry. I have forwarded your question to Dr. Smith. As soon as I receive his response, I will reply. You may also contact his office by calling 212-305-8312 and further information can be found on his profile at: http://asp.cpmc.columbia.edu/facdb/profile_list.asp?uni=crs2&DepAffil=Surgery.

Best wishes to you and your son.

Columbia Surgery December 19, 2012 at 12:21 pm

I have received the following reply from Dr. Smith:

A young healthy 33-year-old is not eligible for TAVR, because surgery would not carry moderate to high risk for him, and because he is likely to have a bicuspid valve. It also depends whether his valve is leaking, obstructed, or both. If the valve is primarily leaking, TAVR is not effective.

Dr. Smith would gladly provide your son with more information to explain this situation further. You may reach his office at: 212-305-8312. Thank you.

Sandy January 1, 2013 at 4:01 pm

I have been researching the PARTNER study on your website and appreciate the opportunity to see reader questions and responses. My husband’s aortic valve stenosis has recently been diagnosed as “severe” with recommendations for replacement. In general, what qualifies a patient for the TAVR procedure? He is 61 1/2 y.o., has good E.F. (65%), no heart enlargement, and although he has not had a catherization, has no medical evidence of heart disease/blockages; he has low CHOL and BP.
Additionally, we live in the Western NY area and wonder if you can recommend MDs in this area who you know to be skilled in this procedure?

Columbia Surgery January 2, 2013 at 12:54 pm

Sandy,

Thank you for your inquiry. I have forwarded your question to Dr. Smith and have received the following response:

A healthy 61-year-old man is very unlikely to qualify for TAVR, in the US or Europe. To be certain, he could be evaluated here in my office, which would include a discussion of conventional valve replacement (his likely best option) and TAVR. In Western New York, I would use Dr. Hicks or Dr. Knight at Strong Memorial in Rochester, or Dr. Green at St. Joseph’s in Syracuse. Depending on how far West you are, the Cleveland Clinic can also do the full assessment for TAVR and conventional surgery, and I would see Dr. Svensson or Dr. Sabik.

I hope this helps answer your question. Wishing you and your husband a healthy and happy new year.

Sandy January 6, 2013 at 12:32 pm

Dr. Smith,
Thank you very much for your response, your M.D. recommendations in our area, and your offer to assess my husband. We have been referred to a Buffalo hospital where minimally invasive robotic surgery can be performed (have not seen too much information on this procedure). Wishing you and Ariana a Happy New Year as well.
Thank you, again.

Linda February 3, 2013 at 7:49 pm

Dr. Smith,
My mother is 89 yrs. old and has been diagnosed with severe aortic stenosis. She has had a pacemaker since March 2012. Mom has chronic problems with anemia. We’re having a difficult time making a decision about the TAVR procedure for her. From what I’ve read, there can be problems with the valve regurgitating blood after the procedure and also an increased risk of stroke and vascular bleeding, which is a concern with her anemia and the need to take blood thinners after the procedure. She was hospitalized in December 2012 with anemia, received 4 units of blood, had CHF issues and was given lasix. After returning home and having more SOB and wheezing, I took her to see her family doc, who measured a peptide that indicates the severity of the CHF–hers was 1245. She is back to her normal now, with minimal swelling and no SOB. Her main complaint is that she tires easily and also has pain with her back, due to osteoporosis. Although I realize her valve can only get worse and cause more CHF symptoms, how do we decide what the best route for her is, since we have no way of knowing what complications she may have following TAVR? I just don’t know if it’s better to let her live as healthy as she can, with the knowledge that her CHF IS going to get worse (and we don’t know when this will happen), or if it’s worth the risk to have the procedure? If there’s a high mortality rate within 2 years of the procedure, she may only have 1-2 years to live without the procedure, but she wouldn’t have any complications from the actual procedure to deal with. How have others made this decision?

Linda

Columbia Surgery February 4, 2013 at 10:21 am

Thank you, Linda, for your inquiry. I have forwarded your comment onto Dr. Smith. As soon as I hear his response, I will reply.

In the unlikely event that you do not hear from him, you can also contact his office directly at: 212.305.8312. Additional information about Dr. Smith can also be found by clicking on the link below:

http://asp.cumc.columbia.edu/facdb/profile_list.asp?uni=crs2&DepAffil=Surgery

Carol April 18, 2013 at 8:13 pm

My dad is 84 and is currently in ICU at a hospital in McComb MS. He has a pace maker and pig valve. Went to the hospital 2 weeks ago with shortness of breath. Was diagnosed was phenomena and congested heart failure. Has 30% buildup on his pig valve and surrounding value. Coded the 2nd night there and was on the vent 3 days. He is breathing with 30% oxygen, his liver went crazy from the shock but it almost back to normal now, the phenomena seems to have cleared but they are having a hard time keeping the congestion on his heart down,his kidney is starting to fail, and he is too week to eat – not to mention that his throat is sore from the vent. Currently getting all his nutrition through the IV because they can’t keep his blood thick enough to insert a feeding tube in his stomach due to altering lasix and blood thinners back and forth. This hospital does not offer the TAVR but Baptist in Jackson MS and UAB in Alabama does. The physicians are at their wits end to keep him alive. Do you think it would be beneficial to see if he is a TAVR candidate?

Columbia Surgery April 19, 2013 at 3:22 pm

Carol,

I am sorry to hear about your father’s troubles. I have forwarded this comment to Dr. Smith. As soon as I hear a response, I will reply.

In the unlikely event that you do not hear from him, you can also contact his office directly at: 212.305.8312. Additional information about Dr. Smith can also be found by clicking on the link below:

http://asp.cumc.columbia.edu/facdb/profile_list.asp?uni=crs2&DepAffil=Surgery

Columbia Surgery April 22, 2013 at 9:47 am

Carol,

I have received the following response from Dr. Smith:

TAVR sounds well worth considering. Not all TAVR centers are approved for treating old pig valves, but UAB or any other nearby center should be able to answer a direct question about their ability to offer the service. For the Edwards valve, Baptist in Memphis and Ochsner Clinic in New Orleans are probably the closest sites that can do this. I believe Jackson in MS would need special pre-approval to get reimbursed.

I hope this information helps. Please let us know if we can be of further assistance.

Veronica May 8, 2013 at 6:57 am

My father is 91 yrs. old and has been diagnosed with aortic stenosis. He has had bypass surgery, stents, a pacemaker and has been on blood thinners for many years. His cardiologist has suggested the TAVR procedure. What is the quality of life after the procedure? After evaluation, is acceptance determined within a couple of days? We do live in NY but are not from the NYC area and for planning purposes, would like to know if more than one trip would be required. Also, if the procedure is successful, can the patient return home by car (4-5 hrs) or should they travel via plane? Thank you.

Leave a Comment

Previous post:

Next post: