The safer new op to replace heart valves
THOUSANDS of people could avoid open heart surgery, thanks to a revolutionary valve replacement procedure, experts have shown. Surgeons have proved the safety of a cutting-edge operation in which a replacement heart valve is inserted through a patient’s groin and threaded through an artery all the way up to the heart.
in Britain, around 6,000 people a year have open-heart surgery for an aortic valve replacement. The procedure is designed to replace a stiff or narrowed valve — known as aortic stenosis — that is not letting blood out of the heart.
But this is a serious undertaking — a 12 in incision is made in the chest, the breastbone or ribs are cracked, the old valves are cut out and replacements are sewn in.
The new technique — called transcatheter aortic valve replacement, or TAVR — leaves the old valve in place and pushes a new, expandable replacement up the artery until it sits just inside it.
it has been used for a few years in patients too old or frail to undergo open-heart surgery — but it has rarely been used in younger patients, as surgeons were not sure whether it would be as effective as completely replacing the old valve.
now, however, two studies presented at the American College of Cardiology conference in new Orleans have shown that the technique could be used for all patients — because it is actually safer than the traditional operation.
The trials, led by Columbia University in new York and Houston Methodist Hospital in Texas, tested two different implants made by rival firms Medtronic and edwards Lifesciences. They showed the chance of dying or suffering a stroke within a year was reduced by up to twothirds with the new procedure.
The results, published in the respected new england Journal of Medicine, involved a combined total of 2,400 people.
Professor Michael Reardon, of Houston Methodist Hospital, says: ‘we now have a minimally invasive procedure that is as good as, or better than, surgery, while at the same time allowing most patients to be out of the hospital within a few days and be back to their normal activities within a week. That’s pretty important.
‘TAVR beat surgery at 30 days for mortality or disabling stroke, quality of life and time in the hospital. in other words, you’re more likely to be alive, without a disabling stroke, get out of the hospital sooner — in half the time — and have a better quality of life one month after getting a new valve.
‘At one year, patients with TAVR were more likely than surgery patients to be alive, without a disabling stroke and without a hospital admission for heart failure.’
He adds: ‘when i [carry out TAVR on] these patients in the morning [later that day] i find them sitting in a chair, eating dinner, asking when they can go home. As a heart surgeon, there is no incision i can make that’s small enough to allow my surgical patients to do that well.’
PROFESSOR Martin Leon of Columbia University, says: ‘ This is beyond anything we could have expected, mostly because surgery is so good in treating aortic stenosis in these low-risk patients.’
experts last night said the findings were a ‘ game- changer’ for heart surgery. Dr Howard Herrmann, of the University of Pennsylvania, says: ‘[The results] shift our thinking from asking who should get TAVR to why should anyone get surgery.’
Dr Robert Lederman, of the national Heart, Lung and Blood institute in the U.S., told The new York Times: ‘is it important? Heck yes.’