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Advanced heart procedure offers alternative to open-heart surgery  

By A. Garvey Rene, MD, FACC, FSCAI | Cardiology

Aortic stenosis affects millions of older Americans each year. Aortic stenosis occurs when there is a narrowing of the aortic valve, resulting in restricted blood flow from the left ventricle to the aorta which serves as the main conduit for blood delivery to every major organ.

Symptoms of aortic stenosis may include:

  • Breathlessness;
  • Chest pain (angina), pressure or tightness;
  • Fainting, also called syncope; and
  • Decline in activity level or reduced ability to do normal activities requiring mild exertion (it may not just be your age).

Those most at risk for developing aortic stenosis include older people, typically those older than age 60 with symptoms usually developing after age 70. This is a result of scarring and calcium buildup on the valve cusp (flap or fold). Young people usually develop aortic stenosis due to a birth defect where only one or two valve flaps grow instead of the normal three, or secondary to a previously untreated rheumatic fever episode in the early years of life.

Since aortic stenosis is a mechanical problem, it requires a mechanical solution. Starting in the 1960s, the traditional fix for aortic stenosis involved open-heart surgery with the surgeon removing the old valve and suturing in a new one. However, over the last decade, a minimally invasive technique named Transcatheter Aortic Valve Replacement (TAVR) has emerged as a new alternative. Normally performed by an interventional cardiologist and cardiac surgeon, the procedure uses standard techniques of cardiac catheterization where the valve is inserted via a small incision through an artery in the groin and positioned carefully inside the patient’s old valve under a live X-ray, known as fluoroscopy, before it is deployed. Once deployed, the new valve replaces the function of the old valve and the obstruction is immediately relieved; truly an immediate cure! Commonly performed under deep sedation instead of general anesthesia, recovery is usually prompt, with the majority of patients being able to go home within two to three days.

Compared to traditional surgery, TAVR was initially reserved for older, frail, more sick patients deemed to not be very good candidates for open-heart surgery. More recent trials looking at short-term data have shown that TAVR does as well or even better than traditional surgery in younger, healthier patients. While a majority of patients with aortic stenosis will likely qualify for this procedure in the near future, there will always be a role for traditional open-heart surgery since there are often anatomical limitations that may be best dealt with open-heart surgery. Nonetheless, this technology is a modern marvel of medicine which will have a more prominent role in not only increasing longevity but also significantly improving quality of life for many.

Source: American Heart Association