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Clinical Updates
New device offers aortic valve replacement to those who are not candidates for open-heart surgery
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UCLA will be among the first centers to offer transcatheter aortic valve replacement (TAVR) to appropriate patients with aortic valve stenosis who are not candidates for open surgery to replace their natural aortic valve. The device, which is crimped to a balloon catheter and delivered percutaneously, has recently been granted FDA approval for use in these patients and can dramatically improve quality of life and survival rates. In a recent U.S. randomized trial, a group of aortic valve stenosis patients receiving only medical therapy had a one-year survival rate of 50 percent; TAVR was shown to improve one-year survival to 70 percent.
Stenosis, or narrowing of the aortic valve, typically occurs when calcium deposits impair the operation of the natural valve’s leaflets, requiring the left ventricle to generate higher pressure in order to push blood through the valve. Patients with aortic stenosis will have a typical heart murmur on physical exam and may develop chest pressure with exertion — similar to angina. Aortic valve stenosis can also result in heart-failure symptoms of shortness of breath and edema and can lead to irregular heart rhythms and fainting.
UCLA is actively evaluating patients as candidates for TAVR.
An alternative to open surgery
Until recently, aortic valve replacement via open-heart surgery was the only effective treatment available to aortic valve stenosis patients. Those who, because of other health considerations, are not candidates for open-heart surgery can now be 
treated using a new replacement aortic valve that is delivered percutaneously.
The transcatheter aortic valve, like many replacement heart valves, has leaflets that are made from bovine pericardial tissue. In this case, the valve is stitched to a balloon-expandable stent that is usually introduced via the femoral artery, and under X-ray and transesophageal echocardiogram guidance is passed through the aorta and expanded inside the natural aortic valve, pushing it aside. The replacement valve begins to function as soon as the balloon catheter deflates to permit the flow of blood. Patients typically enjoy immediate benefit from the procedure in terms of improved blood circulation and, because of the percutaneous delivery, can experience a much more rapid recovery than they would from a traditional open-heart valve replacement.
The UCLA TAVR team
The new device is initially being made available at centers whose experience in doing heart valve operations and percutaneous interventional cardiology procedures best qualify them to perform the new TAVR procedure. UCLA’s team of experts includes interventional cardiologists, cardiothoracic surgeons, anesthesiologists, echocardiographers and a heart-lung machine team.
Study shows significantly better survival rates
The standard treatment for aortic stenosis has been valve replacement through open-heart surgery, but as the incidence of aortic valve stenosis increases with age, some patients are poor surgical candidates for a variety of health reasons.
The FDA has recently approved a new percutaneous replacement valve to treat these patients without open surgery. “The initial rollout is for patients considered to be too high a risk for surgery,” explains Jonathan Tobis, M.D., clinical professor of cardiology and director of Interventional Cardiology. “The expectation is that this will eventually be used for a wider population.”
A randomized clinical study showed a significantly lower one-year mortality rate among patients treated with the new valve compared to those who received only medical therapy. “We expect to see substantial quality-of-life gains from the new procedure,” states Richard J. Shemin, M.D., chief of Cardiothoracic Surgery at UCLA. “Many patients who were formerly bedridden may be able to resume some of the activities of daily life.”
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