Imagine this nightmare scenario—you are told that you have a major problem in your heart that, if left untreated, will definitely kill you. But you’re also told that you’re too sick and weak to survive surgery. So do you sit around waiting to die?
Up until about 10 years ago, that’s exactly what happened to very sick people with aortic valve stenosis, a narrowing of the opening from the heart to the aorta. Then came a “Band-Aid fix” that stretches open the valve, but that works for only a little while. Now, a lifesaving valve replacement option that doesn’t involve open-heart surgery is available—even your doctor may not yet know about it.
FIXING A FAULTY VALVE
In aortic valve stenosis, the valve becomes narrowed (usually because of a buildup of plaque). This causes the heart to work harder and harder to pump oxygen-rich blood out of the heart and to the rest of the body. All that extra effort leads to thickening of the walls of the heart, chest pain and reduced blood flow. Eventually, the heart simply fails to adequately pump blood and could actually just stop. Surgically replacing the faulty valve with an artificial one is the ideal solution, but about one-third of patients are too weak from the extent of their heart disease to survive open-heart surgery.
Standard treatment for these people has been either medical treatment to control high blood pressure that is caused by the heart having to work harder or balloon aortic valvuloplasty, which involves threading a small balloonlike device through an artery in the leg to fit in the aortic valve and widen it.
New approach: Transcatheter aortic valve replacement (TAVR for short) is proving to be safe and far more effective than standard treatment for people who can’t have surgery. It involves inserting a new valve to replace the faulty valve via a technique similar to balloon aortic valvuloplasty—by passing the new valve through a catheter that has been threaded through an artery in the leg to the heart. Its lifesaving value was recently proven in a long-term, international study.
YOU ARE NEVER TOO OLD TO LIVE
Researchers from 21 medical centers in Canada, Germany and the United States compared standard treatment with TAVR in 358 patients with severe aortic stenosis who were not eligible for valve-replacement surgery. As mentioned, standard treatment consists of either balloon aortic valvuloplasty or blood pressure medication. (Of the patients receiving standard treatment in this study, 79% had balloon aortic valvuloplasty.) The patients were followed for five years or until they died.
By the end of the study, 28% of those in the TAVR group and 6% of those in the standard-treatment group were still alive. Participants in the TAVR group lived a median of 19 months longer than those who received standard treatment. You might think that the statistics still sound grim, but the fact is that the average age of the participants at the start of the study was 83. Those who had TAVR were less likely to die of cardiac causes than those in the standard-care group. They also felt better and were less likely to be hospitalized.
And the results for TAVR get even better. Here’s why…
Of the people in the standard-treatment group who were alive at the end of the study period, all but one had actually gone on to get an artificial valve—two ended up getting TAVR on their own and the others became strong enough to undergo surgical valve replacement.
If you (or a loved one) are told you have aortic stenosis but you won’t be able to withstand the operation to replace the valve, ask about TAVR. Don’t settle for a temporary solution when a safer, better treatment is available.