Every year, approximately 300,000 people in the United States need heart valve replacement surgery to treat severe aortic valve stenosis, a condition which can lead to heart failure. However, many of them may now have another option: transcatheter aortic valve replacement (TAVR). Previously restricted to patients whose risk of complications prevented them from having open heart surgery, TAVR received FDA approval in August for use with all stenosis patients regardless of their risk levels.
In this video, San Diego Health host Susan Taylor talks with Paul Teirstein, MD, chief of cardiology at Scripps Clinic in La Jolla and medical director of the Prebys Cardiovascular Institute, about TAVR surgery and who may benefit from it.
Every time your heart pumps, it sends blood out to your body through your aortic valve. The valve then closes to prevent blood from coming back into the heart. If the aortic valve becomes narrowed or weakened, it restricts the flow of blood out to your body and keeps too much blood in your heart. This forces the heart to work harder than it should. Over time, this can cause problems including shortness of breath, fatigue and even heart failure.
Dr. Teirstein says the problem most often begins in older people. “The valve becomes worn out or calcified, and it doesn’t open all the way, and the patient may feel a little short of breath,” he says. “But then over five or ten years, it’s opening maybe only 20 percent and it gets very hard for the blood to leave the heart. The heart gets enlarged, and the patient usually feels very short of breath.”
By age 80, almost 10 percent of people have aortic stenosis. Without treatment, it may lead to heart failure.
Traditionally, stenosis treatment involves open heart surgery to remove the damaged valve and replace it with a new one. Patients generally spend four or five days in the hospital, and full recovery could take several months. Because many stenosis patients are older or may have other health issues, they may not be able to undergo such a major surgery.
In 2007, Dr. Teirstein participated in a nationwide clinical trial at Scripps to test TAVR as an alternative to open heart surgery for aortic stenosis. Instead of making a large incision across the chest and breaking the breastbone to access the heart and replace the valve, TAVR requires just a tiny needle hole, usually in a leg artery. Guided by X-ray technology, the surgeon inserts the new valve into the artery, passes it up to the heart and precisely inserts it inside the old valve. The replacement valve begins to work right away.
TAVR is much simpler and far less invasive than open heart surgery. There is no incision, so recovery time is much faster; patients usually spend only one night in the hospital and are able to resume most activities the next day. Like any procedure, TAVR has risks, but they are low.
“TAVR has transformed patients' lives,” says Dr. Teirstein. “The patients feel about 10 years younger on average, and they can breathe again.”
Scripps cardiology teams have performed about 2,000 TAVR procedures to date. More than 400 patients have a TAVR procedure each year and, now that it has been approved for all aortic stenosis patients, that number is likely to increase. While not everyone with stenosis may be a candidate for TAVR, the exceptions are rare and usually involve other health problems. Scripps TAVR teams evaluate each candidate to determine if the procedure is appropriate.
“Randomized studies have found TAVR outperformed the open chest procedure in low risk patients, and I believe it will be the usual way we treat patients with aortic stenosis in the future,” says Dr. Teirstein. “Down the road I see a lot of new incredible medical advances especially with respect to the heart.”