Tuesday, July 21, 2015

Replacing a Heart Valve Without Major Surgery

Replacing a failing aortic heart valve is actually pretty routine. However, the normal procedure requires cracking the chest, stopping the heart, and cutting into the heart to get to the damaged valve. Because of the traumatic nature of the surgery itself, full recovery is more likely if the patient is relatively young and healthy except for the needed valve. As a result, the surgery is not recommended for patients over about 80 years of age.

Now those older patients have a viable option. Federal regulators recently approved a new technique called TAVR (transcatheter aortic valve replacement) for replacing aortic heart valves in patients who are deemed at high risk from open-heart surgery. In TAVR, surgeons attach a folded-up artificial valve to a catheter, insert it into a main artery and thread it up to the heart, and then open it like an umbrella. The catheter lodges in place, pushing the old damaged valve out of the way. The procedure can be done in minutes with the patient awake and only lightly sedated. Recovery time is minimal.

The TAVR technique is likely to be a lifesaver for the estimated 100,000 patients who are too old or sick for open-heart surgery. One patient it has helped is former Secretary of State Henry Kissinger, age 92. Right now TAVR is only recommended for older and sicker patients because there are only 5 years of data on how long the new valves will last. But if you're 80 and need an aortic valve replacement just to get through the next year, do you really care whether the valve lasts 20-30 years?

Some surgeons think that TAVR will eventually replace open-heart surgery as the method of choice for younger patients as well. That will depend on how long valves replaced by the TAVR procedure last. It matters to someone who is closer to age 50 than 80.

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