For years, extremely invasive open heart surgery was the only option for patients with aortic stenosis—a potentially fatal condition in which the heart’s aortic valve becomes damaged over time.
But there is now a new option for patients: Transcatheter Aortic Valve Replacement (TAVR), which has been performed at University of Minnesota Medical Center since 2012, when the treatment was approved by the Federal Food and Drug Administration.
To learn more about this relatively new treatment, we spoke with University of Minnesota Health Heart Care Cardiologist Greg Helmer, MD.
What is TAVR?
Transcatheter aortic valve replacement is a minimally invasive surgical procedure to replace a diseased aortic valve with a new valve. During the procedure, surgeons or interventional cardiologists will put a thin, flexible tube called a catheter through a blood vessel in a patient’s groin or through a small incision between the ribs. The catheter is used to deliver an artificial valve to the heart. The TAVR procedure is an alternative to open heart surgery.
Who is it for?
TAVR is a minimally invasive treatment for patients with aortic stenosis, a relatively common heart condition that occurs when the aortic valve narrows, usually due to calcium build-up or scarring. This can restrict the blood flow passing through the valve, which in turn can put strain on the heart and may lead to heart failure or sudden cardiac death.
Low-risk patients can have still have their aortic valves replaced by open heart surgery, but for older patients—or patients with other complications—open heart surgery may be too risky or may carry with it a prolonged recovery time. In fact, research shows that many patients with aortic stenosis have in the past gone untreated because of the invasiveness of treatment, the prolonged recovery time of surgery and the associated risks.
“TAVR opens the door for treatment of a much larger patient population that we have never before considered because of their risk and their age,” Helmer said.
There are two now commercially available aortic valves.
There are two commercially available aortic valves that surgeons may use in TAVR procedures. One, a valve by Edwards Lifesciences, uses an expandable balloon to help place the new aortic valve into place in the body. The other is a self-expanding valve from Medtronic, which is warmed to one’s body temperature, then assumes its normal shape and doesn’t require a balloon to be put in place. In both cases, the new valve takes over function from the failing aortic valve.
We offer a new, second-generation TAVR approach.
University of Minnesota Health is one of 50 organizations around country that is now using a new second-generation transcatheter aortic valve from Boston Scientific, called the Lotus valve, as part of a new clinical trial. The new self-expanding valve, which is only offered at three sites in Minnesota, is fully retractable, giving surgeons more opportunity to ensure the new valve is properly in place.
“If the surgeon doesn’t like the positioning of the valve, or he or she doesn’t like the size of it, the surgeon can retrieve it, put a new valve in, or reposition the first valve,” Helmer said.
TAVR is still relatively new and will only get better.
While this procedure has been available in Europe for years, the U.S. Food and Drug Administration only approved the use of TAVR in the United States in 2012, which means new technologies for physicians are still progressing.
“We’re trying to decrease patient risk yet maintain excellent outcomes,” Helmer said.
To do so, researchers continue to develop smaller catheters. Initially, the size of the catheter used to place the new valve was large and required a surgeons to make an incision on the femoral artery. Now, with smaller catheters, surgeons or interventional cardiologists can insert the valve using a simple needle puncture.