TAVR- The Next Big Thing: April 9, 2013

The term TAVR may mean little to you now, but someday it could. Many doctors believe it’s the next big thing in treating advanced aortic stenosis.

“The mortality in the first two years is about 50% if it’s not treated. And that’s how TAVR has shown reduced mortality in very sick patients that previously haven’t been able to be operated on,” says Dr. Stephen Priest, cardiologist with Lee Memorial Health System’s medical staff.

Aortic stenosis is a narrowing of the heart valve, frequently from a buildup of calcium.  The only cure is to replace the faulty valve- until recently that required open-heart surgery.

“You have to actually crack the chest or open up the sternum, stop the heart and put it on bypass and physically go in open the valve, remove the calcium and then sew in a new valve,” says Dr. Priest.

About a third of patients who need a valve replacement are too weak to withstand it. That’s where TAVR comes in. It allows surgeons to implant a new valve without opening the chest. The ‘transcatheter aortic valve replacement’ threads a catheter from the groin to the heart and places the artificial valve.

This new approach already has a new twist. Making it available to sick patients who also have clogged arteries.

“It becomes more dangerous for them to try to put a valve up through those diseased blood vessels in the groin. So the new approach has allowed us to take those high risk patients and go directly in through the chest and avoid all of those potential vascular problems,” says Dr. Paul DiGiorgi, cardiothoracic surgeon on the medical staff of Lee Memorial Health System.

Called a transapical approach, the catheter and valve is inserted through a small incision in the chest. It pierces the heart and implants the valve.

“This has allowed us to do patients who were not candidates before and are actually probably sicker patients,” says Dr. Priest.

Catheter-based approaches may be the next big thing. But are still being measured against the gold standard of an open-heart replacement.

“If the valve holds up as well, doesn’t have leaks, doesn’t degenerate, then it could quite possibly be the standard of care in 5 or 10 or 20 years,” says DiGiorgi.