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The three scariest words to a cardiac patient are “open-heart surgery.” Surgery is daunting enough, but the prospect of having your chest opened can be downright terrifying. Besides the invasiveness of the surgery, the tough recovery makes the process difficult for anyone — and impossible for older, frailer patients.
Thankfully, there’s now an alternative that’s giving older patients a new outlook on their heart prognosis.
It’s called transcatheter aortic valve replacement (TAVR) and it’s quickly becoming a viable option for many people who previously were faced with open-heart surgery, or worse.
Not only is it viable, one surgeon we spoke to thinks it’s going to revolutionize the field.
“We are watching history in the making.”
That’s Dr. John Wang, chief of the cardiac catheterization lab at MedStar Union Memorial Hospital in Baltimore, who spoke to us about TAVR and how it’s changing heart care.
But before we get ahead of ourselves, what exactly is TAVR and what does it do?
It makes sense to start with the aortic valve, which helps carry blood from the heart to the rest of the body. As we age, the valve can harden and become blocked, which restricts blood flow and can lead to shortness of breath, chest pain, and fainting spells.
This condition is called aortic stenosis, and when it becomes severe, patients have only a 50% chance of surviving two years without a valve replacement, according to Dr. Wang.
Until recently the only way to fix the valve was (insert scary voiceover here) open-heart surgery.
TAVR, by contrast, is minimally invasive. It lets doctors replace the faulty valve via a thin stent that is threaded up to the heart by a catheter inserted in the femoral (leg) blood vessel. There’s no open incision, no major anesthesia required, and no long recuperation in a hospital bed.
The procedure typically takes less than an hour, and patients often go home within a day or two. According to Dr. Wang, “It is a much less invasive way to replace the aortic valve.”
Celebrity case in point: Mick Jagger, who underwent TAVR in April and was back touring with the Rolling Stones by June.
This is quite a breakthrough, especially for older patients suffering from aortic stenosis whose physical abilities may be compromised by the condition and who also may not be able to endure open heart surgery.
TAVR was initially approved in 2012 for only the sickest and most inoperable patients. Since then the FDA has approved it for patients considered at high or intermediate risk of surgery; Dr. Wang said he believes the science and the research is on TAVR’s side for further approval.
“In our national American College of Cardiology meeting this spring, data was presented which showed that TAVR is superior to surgery even in patients who are low risk for open heart surgery. We expect FDA approval for this indication later this month. Once that is received, it will be the rare patient that will undergo traditional open-heart surgery.”
Mark Pool, cardiothoracic surgeon at Texas Health Presbyterian Hospital in Dallas, told us that along with technological advances, it is the medical collaboration that has helped propel TAVR forward.
“The breakthrough has been the team approach to the care of the patients,” Dr. Pool said. “The TAVR technology has demanded close collaboration between cardiologists and surgeons, since it combines aspects of both cardiology and surgery. This close collaboration has allowed for skilled decision-making and has allowed for excellent outcomes and for expansion of the technology.”
This collaboration and expansion of technology stands to benefit anyone with severe aortic stenosis, but Dr. Pool pointed out how TAVR specifically provides a new option for older Americans.
“Inasmuch as it is a less-invasive procedure than open surgery, it probably helps elderly and frail patients the most, because an open surgery would be difficult to get through” Dr. Pool said.
It’s not just for the very old, though, he emphasized: “The technology is being proven to be so safe and effective that many patients benefit from it.”
And what is the benefit, exactly? Patients with aortic stenosis suffer a range of physical restrictions caused by fatigue, shortness of breath, dizzy spells and chest pains. TAVR can alleviate these issues and give people their lives back.
According to Dr. Pool, “Replacing the valve with TAVR can allow the patient to live longer and feel better, typically with less shortness of breath and more energy.”
So get familiar with TAVR. It might change the life of someone you know — and soon.
