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HOUSE CALL: New technology offers options for treating aortic valve disease

 


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Aortic valve disease can be crippling. Fortunately there are new options for people previously thought to be inoperable.

Aortic stenosis, one of the most common valve diseases, is the abnormal narrowing of the aortic valve opening. This valve allows blood to leave the heart and enter the aorta, which is the largest artery in the body.

According to The Journal of Heart Valve Disease, about 13 percent of the population over age 75 has aortic stenosis. The journal also reports that it is found in about two percent of the general population.

For those with severe aortic stenosis, the prognosis is poor without aortic valve replacement. Left untreated, about half of patients diagnosed with the condition die within two years of first noticing its symptoms, like shortness of breath on exertion, fainting, chest pain or heart failure.

Approximately 50,000 people in the U.S. undergo surgical aortic valve replacement for severe aortic stenosis.

Surgery is the gold standard.

Surgery to replace the aortic valve is, for the majority of patients, an excellent option and has been improved upon since first introduced in the 1960s.

The recent multiple-site randomized PARTNER trial (a study of treatment for aortic stenosis published in the New England Journal of Medicine) proved that surgical aortic valve replacement is safe and effective, even in elderly patients with chronic medical conditions.

Many patients err in thinking that they are too high risk for valve surgery. Actually, most patients' risk for major complications is surprisingly low; in fact, lower than they or their doctor might think. Unfortunately, it is estimated that one-quarter of patients with severe aortic stenosis are never referred to a surgeon for evaluation.


New option for inoperable patients.

A new technology for inoperable heart valve surgery patients recently became available at high-volume heart surgery centers like Missouri Baptist Medical Center and Barnes-Jewish Hospital. Called "transcatheter aortic valve replacement (TAVR)," in the near future, it also could be approved for patients considered high risk for heart valve surgery.

In TAVR, a tissue valve is threaded from the groin or chest into the center of the patient's aortic valve. A balloon inflates, opening the new valve inside the old one.

TAVR also was evaluated in the PARTNERS trial. Two groups were studied: inoperable and high-risk patients. Inoperable patients either received the valve or were treated with drugs.

At the one-year mark, TAVR proved far superior for prolonging life over medications in inoperable patients.

In the high-risk patient group, traditional valve surgery and TAVR were compared. At the one-year point, the chances of survival were the same.

Presently, the FDA approved TAVR for inoperable patients, but has not yet approved TAVR for high-risk patients. Therefore, the best option for them remains aortic valve surgery.

The real message for people suffering from aortic valve disease is to seek a second opinion from a high-volume center that specializes in valve surgery. Valve replacement, whether by surgery or new procedures like TAVR, is a true lifesaver.

Dr. Michael Mauney is a board-certified general and thoracic surgeon on staff at Missouri Baptist Medical Center. He received his medical degree from Duke University and completed his residency in general surgery and thoracic surgery at the University of Virginia School of Medicine.


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