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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