September 22nd, 2010
06:17 PM ET

Hope for heart patients with minimally invasive surgery

A new heart procedure could save thousands of people each year who are too sick or frail to undergo major surgery, according to a report in the New England Journal of Medicine.

The procedure is used to treat aortic stenosis, a narrowing of the valve between the heart and the artery that carries blood to the rest of the body.  The narrow opening forces the heart to work harder than normal, which can lead to fatigue, weakness and heart failure.  According to Dr. Martin Leon of New York Presbyterian-Columbia Hospital, the study’s lead author, the condition afflicts about 5 percent of all people over the age of 75.

The new procedure is called transcatheter aortic valve implantation, or TAVI. It's essentially a way of inserting a replacement valve without the rigors of open heart surgery.  The valve is made of cow tissue (as are many replacement valves) and reinforced with a steel mesh frame, mounted on a tiny, uninflated balloon. Doctors start by inserting the balloon catheter through the groin, and snake it up to the heart – to the aortic valve.  They expand the balloon to stretch the valve open, and its replacement, braced by the steel, slides into place – pushing the original valve out of the way.

"It's a perfect solution for patients who are not candidates for open heart surgery," according to Dr. Raj Makkar, the associate director of the Cedars-Sinai Heart Institute, which took part in the study.

In a group of 358 patients, researchers compared TAVI to standard non-surgical treatment: typically medication, or a procedure using only a balloon catheter without a replacement valve.  Within a year, 31 percent of the patients getting TAVI had died – which sounds bad, except the death rate was 51 percent among patients getting standard treatment.  Among survivors, the rate of cardiac symptoms in the TAVI group was less than half what it was among those receiving standard care.

Dr. Gregg Stone, another Columbia physician, says the procedure works better than older catheters because the opening it makes is larger and more durable.

“Aortic stenosis is like a cork in the bottle. You can’t get the blood to flow,” he explains. With the balloon catheter alone, “[Doctors] make a tiny tunnel in the cork, but that tunnel can quickly clog up again." Stone says this new procedure is a "less invasive approach" which "replaces the cork with a normal functioning valve."

TAVI is far less invasive than open-heart surgery, but it’s no walk in the park.  There was a higher risk of stroke than with standard therapy, and patients in the study were typically kept in an intensive-care unit for 1 to 2 days, and hospitalized for 5 to 7 days. Leon points out that the patients in the study were, by definition, quite sick in the first place – “the sickest of the sick” – and suffering a variety of ailments unrelated to TAVI.

The study doesn’t address whether TAVI is just as helpful to patients who are sturdy enough to undergo corrective surgery.  But Leon says his research group is on the case, and that their study comparing TAVI to open-heart surgery will be published next year.

soundoff (9 Responses)
  1. Tim

    That is great news indeed......the more non-invasive surgical techniques available, the better.

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    September 22, 2010 at 18:38 | Report abuse | Reply
  2. carolyn

    Is this TAVI technique being used now and if so where can I find a place in the midwest where I can go ASAP?

    September 24, 2010 at 21:43 | Report abuse | Reply
  3. Aortic Valve Replacement

    Are there any other minimally invasive procedures out there?

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