A Non-Invasive Alternative To Open Heart Surgery Is Now A Game-Changer For Low-Risk Patients Needing Aortic Valve Replacement

Big news in the heart health world: TAVR (transcatheter aortic valve replacement) was just approved by the FDA for use in low risk aortic stenosis (AS) patients. Aortic stenosis is one of the most common and most serious valve disease problems, according to the American Heart Association.

And more big news: Doctors at Hartford Hospital, one of the leading cardiac hospitals in the region, played a pivotal role in making TAVR for low risk patients a reality. Led by its Structural Heart Team, Hartford Hospital was one of 65 hospitals in the United States that took part in a trial that allowed low-risk patients to undergo a TAVR procedure.

The FDA first approved TAVR for high-risk patients in 2011, and since then Hartford Hospital has performed more than 1,200 successful procedures for extreme risk, high risk and intermediate risk patients, making it one of the biggest TAVR programs in New England. But low-risk patients had not been approved for the procedure, until now.

Thanks to the August 2019 approval by the FDA, a result, in part, of the aforementioned trial, low risk AS patients are now getting their chance to undergo the life-changing procedure, something Ray McKay, MD, co-director of the Structural Heart Program at the Hartford HealthCare Heart and Vascular Institute, describes as “Earth-moving.” An hour-long procedure gives a retired writer new life

Diana Boehning, a 74-year-old retired technical writer from Lyme, underwent a TAVR procedure at Hartford Hospital in July. For Boehning, who was referred to Hartford Structural Heart Team by her regular cardiologist, the TAVR procedure was a huge success.

After meeting with the team and undergoing bloodwork, ultrasounds and other necessary testing, Dr. Bryan J. Piccirillo, MD, and Dr. David W. Yaffee, two members of the Hartford Hospital TAVR program, performed her procedure.

“It was extraordinary,” says Boehning about her TAVR procedure. “I never experienced any pain. It was so non-invasive. People need to know how noninvasive it really is.”

TAVR vs. SAVR

TAVR is a minimally invasive procedure to replace a narrowed aortic valve that fails to open properly (also known as aortic valve stenosis). TAVR is used as an alternative to conventional surgical aortic valve replacement, known as SAVR, which takes place during open-heart surgery, explains Dr. McKay. For decades, SAVR has been the only way to correct AS, but many AS patients were hesitant to undergo open-heart surgery. The non-invasive TAVR offers an appealing choice for these patients.

Dr. McKay says that TAVR appeals to lowrisk patients like Boehning who won’t have to experience the longer recovery time of SAVR and the invasiveness of open-heart surgery that SAVR entails.

Boehning is now in the recovery phase, going to cardiac rehab, attending nutrition classes and enjoying gardening at home. She says the hourlong TAVR procedure experience exceeded all her expectations.

“It’s no question,” says Dr. McKay. “TAVR extends peoples’ lives, and patients may feel so much better. We are often dealing with elderly people who are very motivated to stay alive to spend time with their children or spouse. It’s a wonderful population of people. It’s very rewarding.”

What exactly is aortic stenosis?

AS is a common cardiac condition in which the aortic valve opening becomes narrowed, preventing a patient’s heart from pumping blood to the rest of the body. AS is one of the most serious cardiac valve disorders; and patients who have developed symptoms have approximately a 50% chance of dying within two years and an 80% chance of dying within five years if their aortic valve is not replaced, says Dr. McKay.

Because AS is a progressive disease, taking many years to develop to the point that the valve narrowing is considered severe, it mainly affects older people. Patients typically experience shortness of breath, fatigue, exercise intolerance, chest pain and dizziness or syncope. Studies show that more than 2.5 million Americans over the age of 75 are currently suffering from AS.

Patients are classified as extreme risk, high risk, intermediate risk or low risk.

“Low risk is defined as having a surgical mortality risk of less than 4% within the first 30 days following surgical aortic valve replacement,” explains Dr. McKay. “Low risk patients are, in general, the healthiest group of patients requiring aortic valve replacement.”

McKay explains that TAVR may be a better option than SAVR for many low-risk patients.

“Approximately 80% of all SAVRs in this country are currently being performed in low risk patients,” explains Dr. McKay. “A significant percentage of these patients will now consider TAVR as an FDA-approved, less invasive technique to replace their aortic valve. The results of the trial showed that TAVR was not only as good as SAVR, but actually superior, with lower combined mortality and stroke rates, shorter hospital stays and lower rehospitalization rates.”

To learn more, tune in to the Hartford

Courant Facebook page at 12 p.m. on Sept.

18th for a Q&A with Hartford HealthCare.

You can also send questions anonymously to connecttohealthier@courant.com.

For more information an TAVR or aortic value replacement in general, contact the structural heart programat Hartford Healthcare at 833-444-0014.

The above content was provided for informational purposes only by Hartford HealthCare and is not a substitute for professional medical advice or treatment. Please consult your healthcare provider for medical advice, or reach out to Hartford HealthCare to schedule an appointment.