July 30, 2019
Just the thought of cardiac surgery is enough to strike fear into almost any heart. But now, patients with aortic stenosis—who previously were subjected to open-heart surgery for aortic valve replacement—can get a much less-invasive procedure, with no incision to the chest or ribs required, AARP reports.
Although under-diagnosed and under-treated, aortic stenosis is a common form of heart valve disease. Dr. Michael Mack, a leading heart surgeon at The Heart Hospital Baylor Plano, told AARP that up to 12% of the elderly population has some form of aortic stenosis.
Replacing the standard open-heart surgery is a less invasive procedure known as TAVR (transcatheter aortic valve replacement), a procedure during which a new valve is inserted into the heart through a leg artery.
TAVR typically used to be reserved for patients who were considered to be unable to withstand surgery. Now new research suggests that TAVR may be the safest option for many healthier patients as well.
Two studies, presented at the American College of Cardiology’s 2019 annual meeting, found that among relatively healthy patients needing valve replacement there were fewer deaths or serious strokes after TAVR: One study showed only 1% for TAVR patients, compared with 2.9% for those who’d had open-heart surgery; the other showed similar death rates but fewer serious strokes.
stopping the heart while a new valve is sewed in to replace the old one.
TAVR was first introduced into the United States in 2006; since then, it has received FDA approval in stages. Today, doctors are performing about 60,000 TAVR procedures and about 50,000 surgical valve replacements every year in the United States.
The fact that the studies found that TAVR was safer for the lowest-risk patients “was kind of a surprise to everyone,” Mack notes. “Everyone figured it would be pretty much the same.”
The procedure will now need to be approved by the FDA for use in this group considered at low risk for surgical complications. But approval won’t mean that surgery will no longer be used for valve replacement; Mack estimates that 25% of patients are not candidates for TAVR, including those who have blockages in their leg arteries or have a particular kind of heart anatomy that makes the procedure too risky.
He offers another caveat: The trials followed patients for only a year after the valve replacements, “and we really don’t know if [the TAVR] valves last as long as surgical valves.” All patients will now be followed for ten years to find out how well they hold up. “It was a pretty compelling study,” he concludes, “but not the final answer.”
Research contact: @AARP