The aortic valve is the last stop for oxygenated blood before it leaves the heart and travels throughout the body. However, blood is rich in calcium and, over time, some of that mineral deposits on heart valves, leading to aortic stenosis, or valve narrowing. Severe stenosis can impair blood flow and generate a heart murmur, chest pain, dizziness and shortness of breath.
Fortunately, people who need an aortic valve replacement to treat their stenosis now have access to the full range of minimally invasive and surgical options right here in San Diego.
Surgical aortic valve replacements were first performed in 1961, and the procedure has become a mainstay for patients with severe stenosis. Surgeons open up the patient’s chest and replace the damaged valve. The procedure is quite effective for many people, but it’s also invasive, and patients face long recoveries.
About a dozen years ago, clinical trials began at Scripps hospitals, and other sites, to test transcatheter aortic valve replacement (TAVR). Rather than opening up the patient’s chest, TAVR uses a catheter to deliver the new valve through veins near the groin or in the chest.
The first clinical trials were for patients who were in poor health and could not tolerate traditional valve replacement surgery. TAVR provided a much less invasive alternative. After the procedure was approved for that group, trials began for medium-risk and, ultimately, low-risk patients. The FDA gave its final approval for TAVR in August 2019.
“We’ve seen some really amazing benefits to TAVR compared to an open procedure,” says Paul Teirstein, MD, chief of cardiology at Scripps Clinic, and medical director of the Prebys Cardiovascular Institute. “Patients spend one night in the hospital and have almost no recovery time at all. There’s no wound, no incision in the chest. Most stay overnight, but we’ve had one leave the hospital the same day. They go home and get back to their usual activities.”
TAVR takes about an hour to perform, compared to three hours for open surgery. Dr. Teirstein notes that the procedure also offers other advantages, including:
- The risks of stroke and rehospitalization are cut in half
- Kidney disease is reduced by 66%
- Incidence of severe bleeding is reduced from 25% of patients to 4%
- Many patients who undergo a traditional surgery must spend time rehabilitating in a skilled nursing facility, which has not been necessary with TAVR
“This is a really transformative procedure,” says Dr. Teirstein. “For many patients, the new valve sets the clock back about 10 years.”
Now that TAVR has received final regulatory approval, many low-risk patients can also benefit from the technology. But TAVR is only one milestone on a long journey. Scripps is currently engaged in around 70 clinical trials to improve cardiovascular health, including one for a mitral valve replacement and another for a valve that stops aortic regurgitation.
The technology has gotten so good, and the procedures so well refined, that interventional cardiologists can stop a major heart attack in its tracks — preserving heart muscle and dramatically improving quality of life.
“We’re incredibly lucky to be physician investigators during this revolution in medicine,” says Dr. Teirstein. “Patients want the technology to make the problem go away — and that’s exactly what we’re doing.”