Did you know that heart disease remains the leading cause of death in the United States? Thankfully, advances in treatment are changing the lives of patients suffering from heart disease. With minimally invasive techniques, patients now have more treatment options than they did in the past.
One example is transcatheter aortic valve replacement (TAVR), a minimally invasive procedure for replacing a diseased aortic valve. A common condition in the aging population is a heart valve disease called aortic valve stenosis, a progressive narrowing of the aortic valve caused by calcium deposits. The main valve in the heart, the aortic valve regulates the amount of blood flow out of the heart to the rest of the body. In aortic valve stenosis, the narrowing of the aortic valve puts additional strain on the heart. This can result in symptoms such as fatigue, shortness of breath, chest pain, and dizziness. Over time, aortic valve stenosis can lead to heart failure if it is not treated.
Traditional treatment for aortic valve stenosis has been open heart surgery to replace the aortic valve. As many older patients are considered too high risk for conventional surgery, treatment for aortic valve stenosis remained limited until minimally invasive techniques became available.
TAVR Revolutionizes Aortic Valve Stenosis Treatment
A multidisciplinary team of cardiovascular experts at Brigham and Women’s Hospital first began using TAVR in 2009 as part of a series of clinical trials – the PARTNER trials. TAVR has since been approved for patients at intermediate or high risk for open heart surgery, and it is now being studied in patients at low risk for conventional surgery in the new PARTNER 3 clinical trial.
TAVR is performed in a cardiac catheterization laboratory and can be done without the use of general anesthesia, eliminating one of the issues that many older patients with other medical conditions face in open heart surgery. With TAVR, patients experience a quicker recovery than they would from a traditional, open-heart valve replacement. The entire TAVR procedure takes about 90 minutes, and patients resume daily living quickly with a high quality of life.
During TAVR, a catheter with a stented valve is guided into the heart through a small incision in either the upper leg or groin (transfemoral approach), the upper chest (transaxillary approach), or the chest between the ribs (transapical approach). The valve is then deployed, and the catheter is removed. Advanced imaging equipment is used to guide and position the catheter and confirm that the new valve is working properly before the catheter is removed.
“We have one of the most experienced programs in transcatheter aortic valve replacement, having performed over 700 TAVR procedures,” said Dr. Pinak B. Shah, Director of the Brigham Cardiac Catheterization Lab, Medical Director of the Structural Heart Disease Program at the Brigham, and a Co-Principal Investigator of the PARTNER 3 trial. “With a team of experts including cardiac surgeons, interventional cardiologists, cardiac anesthesiologists, and cardiovascular imaging specialists, we continue to seek new breakthroughs for patients with heart valve disease and other cardiovascular conditions.”