Traditional treatment for severe aortic stenosis - a narrowing of the valve that delivers blood to the heart—has been to open the chest, remove the faulty valve and replace it with a new one.
For many years there was little that could be done to treat severe aortic stenosis if the patient was unable to undergo open heart surgery due to age and/or the severity of their condition, but now there is hope. In August 2012, the heart team at St. Joseph Mercy Ann Arbor began performing a new procedure - the transcatheter aortic valve replacement - or TAVR.
The surgeon makes an incision in the groin (transfemorally) or through a space in the rib cage (transapically) and threads a catheter into the blood vessel to reach the aortic valve. A balloon on the end of the catheter is inflated forcing open the stiff leaflets of the damaged aortic valve. The replacement valve - made of cow heart tissue (valve leaflets) that is sewn onto an expandable stainless steel cuff (stent) - is compressed to fit in the catheter then positioned within the center of the bad valve and expanded to fit snuggly within the space. (Currently, physicians can choose replacement valves in two sizes (23 mm or 26 mm) based on the size of the receiving vessel.)
A key advantage is that the procedure is performed on a beating heart and the patient does not have to be put on a cardiopulmonary bypass machine, so it is far less stressful. The transfemoral approach usually requires four to five hours to complete; the transapical slightly less at three to four hours.
Developed in 2000 by a French cardiologist. TAVR was approved for use in the United States in 2011 slightly ahead of schedule when clinical trials proved remarkably successful.
However, TAVR is still relatively new and not without risk. Patients must meet specific requirements in order to have this procedure and accept the device safely since there are side effects and a slightly higher rate of complications than traditional, open-heart surgery. The Federal Drug Administration (FDA) has only approved this treatment in cases where patients have severe aortic stenosis with significant symptoms and have been deemed inoperable by two independent cardiac surgeons.
To learn more about TAVR, please contact Nurse Navigator, Kimberly Simons for more information 734-712-5830.
NewHeartValve.com is a helpful, educational online resource for patients and their caregivers.
Dr. Arthur Szyniszewski
holding the valve