New Minimally Invasive Procedure Helps Patients with Aortic Stenosis

Aortic stenosis affects about 12 percent of people over 75, about a fourth of whom have disease so severe it mandates surgical repair.

Suburban Hospital’s team of cardiac experts now provides transcatheter aortic valve replacement (TAVR) for certain patients who require treatment for aortic stenosis, a narrowing in the opening of the aortic valve that constrains the flow of blood from the heart to the rest of the body.

The narrowing requires the heart to pump with increased force in order to move blood through the narrowed or stiff valve. Consequences can be serious and include heart failure, a life-threatening condition.

Aortic stenosis affects about 12 percent of people over 75, about a fourth of whom have disease so severe it mandates surgical repair. Many patients, however, have risks that render them poor candidates for open-heart surgery, the gold-standard approach. Clinical studies have demonstrated a clear benefit for TAVR among such patients with regard to improving both quantity and quality of life. More recent studies have shown similar benefit for TAVR among many patients who are candidates for conventional surgery but are at somewhat increased risk of complications. Current trials are evaluating whether TAVR may be of benefit among patients at standard risk for surgery.

A team that includes cardiac surgeons and interventional cardiologists performs the procedure in the cardiac catheterization lab. In 90 percent of cases, no incision is required; the new valve, made of tissue obtained from the heart of a pig or cow, is inserted via the femoral artery in the thigh.

The surgeons enter the artery with a small needle puncture and insert a plastic tube that holds the compressed valve. The valve is then positioned and released under X-ray guidance. Most TAVR patients require only light sedation, provided by an anesthesiologist. The procedure itself takes about 1.5 hours, and patients are up and moving around the same day or the next morning. Most go home in two to five days and are back to normal activity within a week.

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