Open heart surgery—without ‘open’ or ‘surgery’
Although most people may never have heard of aortic valve stenosis (AS), this condition afflicts an estimated 7 percent of the population 65 and older. Left untreated, symptomatic AS carries with it a significantly worse survival rate than metastatic breast, lung, colon and prostate cancers.
AS is the narrowing (stenosis) of the aortic valve, which restricts the flow of blood from your heart’s left ventricle to the entire body. The narrowing may be present at birth, or acquired over time as a result of rheumatic fever or radiation therapy. But most cases are directly related to aging, as calcium accumulates within the valve’s leaflets.
Over time, these leaflets become stiff, reducing their ability to fully open and close. As a result, the heart must work harder to overcome the restriction.
In most cases, severe AS has required open heart surgery to replace the diseased valve. Unfortunately, a growing number of patients are poor candidates for the surgery because of their overall frail health or other health complications that make the procedure too risky.
For many, that meant a virtual death sentence. Half of inoperable severe AS patients will die within one year and nearly 70 percent within two years, said Richard Zelman, MD, director of Interventional Cardiology at Cape Cod and Falmouth hospitals.
Today, that dismal prognosis is changing rapidly with the emergence of a new technology and procedure available to the sickest and highest-risk patients on Cape Cod and elsewhere.
Transcatheter Aortic Valve Replacement, or TAVR, avoids the trauma of surgically opening the chest, dividing the breastbone and replacing the damaged aortic valve with a mechanical or biological one.
TAVR surgeons, known as “interventionalists,” enter non-invasively through a small needle hole, usually at the upper leg. They place a sheath, which is a small hollow tube the diameter of a pencil, in the femoral artery.
Guided by X-ray and ultrasound technology, the doctors then insert a catheter tube with a balloon on its end across the diseased valve. They briefly inflate the balloon to make room for the new valve to be inserted and expanded inside the old one.