Less Invasive Heart Valve Replacement Gives New Option for Aortic Stenosis
Patients with severe aortic stenosis who are too frail to endure traditional valve replacement surgery may benefit from a promising new treatment offered at the URMC Heart and Vascular Center.
URMC’s multidisciplinary valve team is offering transcatheter aortic valve implantation (TAVI), a recently approved approach to replace diseased aortic valves. Traditional valve replacement requires open-heart surgery with a lengthy recovery, which may be too rigorous for some elderly patients or those with co-morbidities who cannot endure the procedure.
During the TAVI procedure, the team accesses a leg artery, performs balloon dilation of the diseased aortic valve, and then advances a new heart valve across the diseased valve. The new heart valve, which is mounted on a metal frame, is then expanded into its permanent position.
“This is a real game-changer for the field of cardiology,” said Frederick S. Ling, M.D., director of the Cardiac Catheterization Laboratory. “We’ll be able to perform life-saving surgery for people who were previously considered inoperable. This is an incredible step forward as, prior to this advance, there was nothing we could offer to help these very sick patients.”
The ground-breaking PARTNER trial, published in the New England Journal of Medicine, demonstrated the benefits of TAVI. In this study, 358 patients with severe aortic stenosis, who were unable to undergo surgery, were randomized to TAVI or the standard therapy of balloon aortic valvuloplasty. TAVI decreased mortality after one year by 45 percent.
Edwards Lifesciences chose the URMC Heart and Vascular Center, led by Joseph Delehanty, M.D., to use its valve because of its team approach for the management of valvular heart disease. To support this technology, the Center created the URMC Valve Center – a multidisciplinary team of experts in cardiothoracic surgery, interventional cardiology, cardiac imaging, cardiac anesthesiology, and vascular surgery – dedicated to providing superior care for patients with advanced aortic valve disease.
In addition, an operating room was renovated and upgraded to accommodate the procedure. A hybrid of a traditional surgical space and a cardiac catheterization suite, it is equipped with enhanced imaging technology to provide greater visualization for the team.
“This new procedure has the potential to revolutionize cardiac surgery and our patients will benefit tremendously,” said George Hicks, M.D., chief of Cardiac Surgery.
Complex Issues Require Advanced Care
Treating heart valve disease requires a thorough understanding of the disease process and treatment options. The URMC Valve Center offers transthoracic and transesophageal echocardiography with 3-D imaging, cardiac magnetic resonance imaging, multi-detector computed tomography with 3-D reconstruction and cardiac catheterization. Â
The new artificial valve is about the size of a man’s ring. The flaps of tissue, or valve leaflets, that open and close to regulate the flow of blood in one direction are sewn onto a balloon-expandable stainless steel frame. During the procedure, the valve is crimped down to the approximate diameter of a pencil and then delivered into the body via the RetroFlex 3 transfemoral delivery system. This gives physicians controlled placement of the valve, minimizing impact to surrounding structures within the heart. Once in place, it is intended to function like a normal, healthy valve with proper blood flow.
Patients who undergo TAVI recover more quickly, when compared to open-heart surgery, and are discharged from the hospital after five to seven days instead of 10 days or more.
Benefits of Team Approach
URMC Heart and Vascular Center’s team approach to patients with severe aortic stenosis includes:
- A cardiac surgeon determining the most appropriate candidates for TAVI, and playing a critical role in ensuring optimal outcomes by offering their surgical expertise as needed during the transfemoral TAVI procedure.
- The interventional cardiologist and cardiac surgeon together evaluating each potential candidate for transcatheter valve replacement.
- The interventional cardiologist and cardiac surgeon, acting as a team, performing transfemoral TAVI in URMC’s new hybrid operating room aided by imaging equipment to assist with optimal valve delivery and placement.
- An anesthesiologist responsible for ensuring safe delivery of anesthesia before and during the procedure, monitoring the patient during the procedure and overseeing post-procedure care.
- The echocardiographer using ultrasound technology to examine and evaluate the function of the heart including valve function and blood flow.
- The hybrid operating room staff assisting with device and room preparation, and closely monitoring the patient and procedure environment during and after the procedure.
With the region’s largest team of nationally recognized experts, research at URMC in heart rhythm disorders, heart failure, and sudden cardiac death, has changed treatments for patients around the world.
URMC is one of the nation’s leaders in the development of ventricular assist devices (VAD) for the treatment of heart failure and is home to the region’s only Atrial Fibrillation Center, providing advanced treatments that are often a cure for atrial fibrillation.
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