Aortic Heart Valve Replacement Can Now Be Done Without Surgery
Recently a story that described pulmonary heart valve replacement without surgical incision. The procedure appeared to be safe and effective in a small group of patients. Now the next obvious question is what about the aortic valve? The answer is that the aortic valve can also be replaced this way–it appears that this breakthrough will allow older and more frail patients who seemed to be too sick to survive a heart valve surgery that involved a large incision in the sternum and the heart bypass machine, may be able to tolerate this less invasive option. The procedure has been performed on a limited basis in Canada and Europe.
A transcatheter approach to reach the aortic valve is used (meaning that the heart is reached using a small thin tube placed in the femoral artery in the groin). The valve is implanted using a balloon-expandable stent valve placed in the femoral artery. Fifty symptomatic patients who had severe aortic stenosis were selected in the most recent study. Physicians agreed that these fifty patients had very high medical risks for traditional open heart surgery. Aortic valve implantation using the heart catheterization throught the femoral artery was successful in 86% of the patients. Mortality was 2% during the procedure. Discharge home occurred at about 5 days after the procedure. With experience, the success rate for the procedure increased from 76% in the first 25 patients to 96% in the second 25 patients. Also, the 30-day mortality dropped from 16% to 8% . After aortic valve placement, there was a significant improvement in left heart pumping function, and improved function in the other left heart valve called the mitral valve. This improvement was still present after 1 year. The structure of the aortic valve did not deteriorate after one year.
ref: http://circ.ahajournals.org/cgi/content/short/CIRCULATIONAHA.107.698258v1
http://www.ncbi.nlm.nih.gov/pubmed/18326007
