TAVR Procedure Offers Minimally Invasive Option for Aortic Valve Replacement
A 75-year-old rock legend’s recent reported heart valve surgery has put the spotlight on one of the decade’s top heart care advances .
The transcatheter aortic valve replacement procedure, more commonly called TAVR (pronounced tavver), presents an option for people with severe aortic valve disease to live a longer, fuller life. Many of those people are in their 70s, 80s and 90s.
“Eight or 10 years ago, we didn’t have much hope for people with severe degenerative valve disease whose health made open heart surgery prohibitive,” says Saeb Khoury, MD, interventional cardiologist with St. Elizabeth Healthcare. “We would treat their symptoms, and they would pass away in a year or two.”
The aortic valve is the gateway through which the heart pumps blood into the aorta, to be carried to the brain and the rest of the body. When calcium builds up over time to narrow the valve, the heart has to work harder and blood flow decreases. As the narrowing becomes more severe, a person may experience chest pain, short of breath and extreme fatigue.
With the minimally invasive TAVR procedure, people who don’t qualify for open heart surgery have a chance to get a new valve and a better life.
Dr. Khoury says chronological age is not a factor. He has performed TAVR on a woman who is 97. He describes an 89-year-old man who underwent TAVR five years ago and is walking into his office and complaining about his knees hurting. “Five years ago, he couldn’t walk. Now he’s walking and doing great. I’ve seen people previously wheelchair-bound and bed bound who are able to dance after this procedure.”
How TAVR Works
A heart valve team, including an interventional cardiologist and cardiothoracic surgeon, work together in a specially designed procedure room to perform TAVR. The patient is asleep as doctors make a small needle puncture, typically in the groin area. The doctor then inserts a very long and narrow tube, called a catheter, through an artery to the location of the heart and aortic valve.
At the end of the tube is a new heart valve, made from animal tissue. The doctor precisely places the new valve inside the faulty valve. The placement of the artificial valve pushes aside the leaflets of the old valve. The new valve restores smooth blood flow into the aorta, providing oxygen-rich blood to the rest of the body.
Dr. Khoury explains that although TAVR doesn’t replace the need for open heart surgery, it does provide an effective alternative for those not strong enough to undergo surgery. With TAVR, patients experience less blood loss, less risk of infection and less pain during recovery.
TAVR has already been approved by the U.S. Food & Drug Administration (FDA) for patients with severe aortic stenosis who have high risk or intermediate risk of life-threatening complications from open heart aortic valve replacement surgery.
A Bright Outlook
Researchers recently announced that clinical trials with people who have low risk for open heart surgery have shown that TAVR is producing better results than surgery.
“Initially, we didn’t know the long-term results of TAVR,” Dr. Khoury says. “Now we have eight years of data that show we’re doing very well. With FDA approval [expected this year]to use TAVR on people with low surgical risk, we expect a significant increase in TAVR procedure volume.”
St. Elizabeth Healthcare began offering TAVR in 2014. The valve team has performed about 170 cases to date, with results at the high end of the national average.
“This is dramatic,” Dr. Khoury says. “We now have this option that extends not just life expectancy but quality of life for people with severe valve disease.”
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