Catheters: An Alternative To Open Heart Surgery For The Elderly
It’s common for the elderly to experience aortic stenosis, a hardening or narrowing of the aortic heart valve.
Open heart surgery’s the standard way to replace or repair the valve, but a less invasive procedure called transcatheter aortic valve replacement (TAVR) is now available – an alternative that’s much easier on the elderly.
In this edition of Vital Signs, Dr. Sarah Gualano, an Assistant Professor of Internal Medicine at UT Southwestern Medical Center and Medical Director of the Cardiac Catheterization Lab, explains how TAVR works.
From Dr. Gualano’s interview…
How the procedure works: “We typically put the catheter into the large artery in the groin, occasionally through a small incision in the chest. The valve is kind of compressed. It’s put at the location of the previously existing valve that’s narrowed down and causing the problem. The old valve remains intact. The new valve essentially squishes the old valve against the wall of the aorta, and the new valve starts functioning like a surgical valve replacement. Nothing is cut out, just put in. The beauty of that is the patient is able to avoid a huge incision in the chest, and they can avoid use of the heart and lung bypass machine – all of which are associated with a longer recovery."
"The Mitral Valve repair is a little different. It’s not a replacement. We go in a vein of the groin and we’re able to cinch together the Mitral Valve to prevent it from leaking as much."
Why open heart surgery remains the “gold standard” for valve repair and replacement: “Mostly because we have decades’ worth of data to say that open heart surgery is successful, that the valves that were using to replace the native valves are durable and will last a long time.
"The newer technologies? We have a fair amount of data on them, but not nearly the length of follow-up that we have for traditional surgical valves. That’s a concern. Are the newer valves going to perform in the same way that the surgical valves do? We think so, but we can’t say for sure."
Who, besides the elderly, can have TAVR? “It’s an alternative surgery for people who are at either prohibitive risk of undergoing traditional surgical valve replacement or of high risk. And whether the risk is high because of co-morbidities – say, they severe lung disease or kidney disease – that may be what puts them in the category of acceptable for transcatheter valve replacement.
Risks involved? “There’s a slightly higher risk of stroke during some of the transcatheter replacement procedures. There’s a slightly different risk of bleeding. Not so much bleeding through the incision in the chest, but through the area where the valve is implanted, like the groin. It isn’t a risk-free procedure. But that’s where the team of doctors taking care of the patient can help balance the risks and benefits for each different approach and make an educated decision with the patient in terms of what the route is for them.”
For More Information:
Video of Transcather Aortic Valve Replacement (TAVR)
Mitral Valve Clip Repair Procedure