New Heart Valve Possible for More Patients with TAVR

**By Moses Mathur, MD, MSc, FACC**

HeartbeatLess than a decade ago, replacing the aortic valve required open-heart surgery and involved a long recovery.

Then in 2002, the first transcatheter aortic valve replacement (TAVR) was performed in France – a tipping point that spurred a period of intense clinical research and medical device development. The culmination of these efforts led to Food and Drug Administration (FDA) approval of the first TAVR device in the United States in 2011.

Today, select hospitals around the country with comprehensive heart care programs, like Virginia Mason, offer the catheter-based procedure for people affected by severe aortic stenosis, which happens when calcium deposits form and reduce blood flow through the aortic valve.

Treating severe aortic stenosis in Seattle

Between 2015 and 2017, Virginia Mason interventional cardiologists performed 112 TAVR cases in a specialized “hybrid” cardiac catheterization lab.

One patient who underwent the procedure last year is 90-year-old Juneau, Alaska resident Finn Larsen, who learned about TAVR from his family doctor. Knowing Larsen had long suffered from shortness of breath, his doctor told him he might be a candidate for the minimally invasive surgery given his symptoms and age.

“My choice to avoid open-heart surgery made the decision to have TAVR an easy one,” said Larsen, a father of three who has six grandchildren and two great-grandchildren. “I definitely feel better and take solace in knowing that I can soon begin cardiac rehab and resume normal activities.”

How TAVR works

Almost all TAVR procedures can be performed through catheters (small plastic tubes) placed in the arteries of the leg or hand. For a minority of cases, where leg arteries are too small for TAVR delivery, several alternative approaches exist. The most appropriate TAVR delivery approach is finalized after a discussion between the interventional cardiologist and heart surgeon, who work together.

Similar to how a stent is placed in a coronary artery, TAVR delivers a collapsed, biologic replacement valve to the aortic valve site through a catheter. The patient’s diseased aortic valve is replaced without being removed. The new valve is inserted within the old valve using X-ray and ultrasound guidance. Once delivered, the replacement valve instantly takes over the job of regulating blood flow.

Most TAVR procedures are performed under light anesthesia without a breathing tube, which helps with faster recovery. In most cases, patients are able to walk the next day and are usually discharged within one to two days of the procedure.

Risk vs. rewards

As with any procedure, TAVR is associated with some risks. Potential complications include vascular injury, post-procedure stroke, the need for a permanent pacemaker, or a leak allowing blood to flow around the TAVR valve. With improvements in device design and implantation technique, the risk of complications has diminished significantly over the last few years. These advances have enabled patients considered too frail for traditional heart surgery to receive the life-saving procedure.

Good candidates

Currently, TAVR is approved for patients with symptomatic, severe aortic stenosis, who are at intermediate or high risk for undergoing open-heart surgery. Advanced age increases risk, as does chronic illness or a condition that would complicate open-heart surgery and recovery. A care team comprised of specialists in cardiothoracic surgery, interventional cardiology, anesthesiology and echocardiography work together to determine the best candidates for TAVR.

People interested in learning if they might be candidates for TAVR should speak with their primary care provider or a cardiologist.


Moses Mathur, MD, MSc, FACC, is board certified in interventional cardiology, general Dr Moses Mathurcardiology, echocardiography and internal medicine. He practices at Virginia Mason Hospital and Seattle Medical Center. Dr. Mathur specializes in structural and interventional cardiology, transcatheter aortic valve replacement (TAVR), MitraClip, Watchman, atrial septal defect (ASD) and patent foramen ovale (PFO)

 

Comments

  1. Jack Sutton says:

    Thanks for the update. This was well explained. Mike Longo is my cardiologist.

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