An alternative to open-heart surgery? How TAVR is changing the game for aortic stenosis patients

This content is sponsored by MedStar Washington Hospital Center

Aortic stenosis is one of the most common and most serious valve disease problems, according to the American Heart Association. It’s a condition that used to require an involved open-heart surgery to treat it, but now patients have a less-invasive option that improves their overall experience.

Aortic stenosis is caused by the progressive narrowing of the main heart valve through which blood flows from the heart to the rest of the body. The condition is very common, particularly in older patients, said Dr. Toby Rogers, an interventional cardiologist at the MedStar Heart & Vascular Institute at MedStar Washington Hospital Center.

Patients who have aortic stenosis often experience shortness of breath, chest pain and dizziness even when doing something as simple as walking across the room. Historically the only way to remedy the condition was open-heart surgery, however a technique called Transcatheter Aortic Valve Replacement (TAVR) is now offering hope to many who suffer, Dr. Rogers said.

“You can imagine open-heart surgery is a big deal and it’s very stressful on the body, and the older you are, the more stressful a big surgery is,” he said. “So TAVR is an amazing new technology that over the last decade has revolutionized cardiac surgery in that we can now replace that heart value through a little tiny catheter in the groin with the heart still beating; in fact, with the patient awake … and we can replace the heart valve and improve the blood flow to the rest of the body.”

At first TAVR was only available to people who were too ill to undergo open-heart surgery because of underlying health conditions, but clinical trials have shown that TAVR is a good treatment for most—if not all—patients with aortic stenosis.

“I think within the next 12 months, we will expect that the FDA will approve TAVR so that we can offer it to anyone with aortic stenosis,” Dr. Rogers said.

During a TAVR procedure, patients are under conscious sedation – a benefit because they are relaxed and not on a ventilator, which has risks such as getting a chest infection.

The doctor then takes the heart valve and crushes it down onto a catheter so that it is small enough to go through an artery. Then the catheter with the new valve is threaded through the artery in the groin to the heart and then positioned with the help of X-rays and ultrasounds. The new heart valve is implanted inside the old valve, opening and closing with every heartbeat.

TAVR allows patients to spend significantly less time in the hospital compared to open-heart surgery, Dr. Rogers pointed out.

”We’ve gone from a process where open-heart surgery patients would be in the hospital for a week or more, to a process where people are having a heart valve replacement and they are out sometimes the day after the procedure, which is a revolution in this treatment,” he said.

In addition to less time in the hospital, those who undergo the TAVR procedure experience fewer complications because there is no major incision, Dr. Rogers said.

”In terms of getting back to normal-day activity, getting back to work, TAVR allows for much faster recovery,” said Dr. Rogers, who added that patients still need to take it slowly at first.

MedStar Washington Hospital Center has been on the cutting edge when it comes to TAVR, Dr. Rogers said. The hospital has been part of the TAVR program since it first took off in the United States and continues to test some of the newest developments with the procedure and its technologies.

“MedStar Washington Hospital Center was part of the first waves of hospitals to perform this procedure. And we have performed almost 2,000 of these procedures now,” Dr. Rogers said.

Read more about TAVR and listen to a podcast from Dr. Rogers here.

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