Replacing Heart Valves Without Surgery

February 20, 2017 Aidan R. Raney, MD


New Hope for Patients with Severe Aortic Stenosis

About 1.5 million Americans have aortic stenosis, a narrowing of the valve that controls blood flow from the heart to the rest of the body. Severe aortic stenosis (AS) is life-threatening, but the standard treatment — open heart surgery to replace the damaged valve — is too risky for some patients, who may be elderly or frail. The good news? At St. Joseph Hospital in Orange, California, these patients now have a life-saving alternative: Transcatheter Aortic Valve Replacement (TAVR).

Recently FDA-approved for high-risk patients with severe AS, the TAVR method uses a catheter to insert a new valve that takes over the function of the damaged one. “For patients who can’t withstand open heart surgery, TAVR is a great alternative,” said Aidan R. Raney, MD, board-certified cardiologist at St. Joseph Hospital, Orange. “With TAVR, most patients go home in a day or two. The surgical approach is just as effective, but involves a four- to five-day hospital stay and a more challenging recovery.”

AS is an illness of aging that occurs most often among people in their 70s and 80s and causes symptoms like fatigue, shortness of breath, chest pain and fainting. “AS happens over time as calcium deposits gradually build up in the valve, causing it to narrow and not open and close fully. There’s no way to prevent or avoid it,” Dr. Raney said. People can live with mild or moderate AS for some time, but a severely narrowed valve can damage the heart. Treatment is necessary for most patients.

With the TAVR method, a small incision is made to access the artery near the patient’s hip. Guided by sophisticated imaging, the doctor threads a catheter — a thin, hollow tube — through the femoral artery to the heart. A slender wire follows with a fully collapsible heart valve mounted on a tiny balloon at the end. As soon as the valve is in position, the doctor inflates the balloon, opening the new valve like an umbrella and pushing the old one aside. The new valve, surrounded by a tiny mesh cage that keeps it expanded, starts working right away.

The vast majority of patients notice a significant improvement in their symptoms almost immediately. “They feel better and they can do things like go for a walk, climb the stairs, and even things they couldn’t do before or avoided doing because of their AS,” Dr. Raney said. “It has a big impact on their quality of life.”

While TAVR is currently approved only for high-risk patients, clinical trials are testing its effectiveness for those at intermediate risk. “Valve replacement surgery is still the gold standard for younger, healthier patients, but for elderly patients, TAVR will become the treatment of choice going forward,” Dr. Raney added.

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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.



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