New, Less Invasive Method for Performing Aortic Valve Replacement

A new, less invasive way to perform transcatheter aortic valve replacement has been developed by researchers at the National Institutes of Health (NIH).

Aortic valve stenosis is a lethal heart condition that involves the narrowing of the heart's aortic valve which reduces blood flow through the heart. The transcatheter aortic valve replacement (TAVR) is a procedure widely used to treat aortic valve stenosis.

For about 85% of patients with this condition, doctors typically perform TAVR through the femoral artery in the leg. But for the other 15%, doctors must find a different access route. The most common alternative routes are through the chest, which requires surgery and are associated with significantly more complications.

Benefits of Transcatheter Aortic Valve Replacement Over 3 Years Confirmed By Study
TAVR yielded lower mortality rates after three years compared with medical therapy in patients deemed to be ineligible for conventional aortic valve surgery, finds a study.

‘A new, less invasive way to perform transcatheter aortic valve replacement has been developed by National Institutes of Health (NIH). ’

A new, less invasive way to perform transcatheter aortic valve replacement has been developed by researchers at the National Institutes of Health (NIH).

The new approach, called transcaval access, will make TAVR more available to high risk patients, especially women, whose femoral arteries are too small or diseased to withstand the standard procedure.

The Journal of the American College of Cardiology published the findings.

Outcomes for Patients One Year After Transcatheter Aortic Valve Replacement
A new study published in the JAMA revealed that among patients who underwent transcatheter aortic valve replacement (TAVR), the death rate after one year was nearly one in four.

Transcaval access, which can be performed in awake patients, involves electrifying a small wire so that it crosses between neighboring blood vessels in the abdomen. The technique calls for making large holes in both the abdominal aorta and the inferior vena cava, which physicians previously considered dangerous because of the risk of fatal bleeding.

The new method was developed by researchers at the National, Heart, Lung and Blood Institute (NHLBI) and tested in a trial on 100 patients at 20 hospitals across the United States. Researchers said it proved successful in 99 of the patients.

Aortic Stenosis Best Treated With Transcatheter Aortic Valve Replacement (TAVR) in the Elderly
Patients undergoing a minimally invasive procedure to replace the aortic valve without doing open heart surgery have better outcomes after five years than patients who did not have surgery at all.

"This is a seminal study," said the lead author, cardiologist Adam B. Greenbaum, co-director of the Henry Ford Hospital Center for Structural Heart Disease, Detroit. "It challenged conventional wisdom, objecting to the idea of safe passage between the vena cava and the aorta. More important, it is the first of many non-surgical minimally-invasive tissue-crossing, or so-called transmural catheter procedures developed at NIH that can be applied to diverse fields of medicine."

Robert J. Lederman, a senior investigator in NHLBI's Division of Intramural Research who led the study, said researchers developed the method to address a specific clinical need, even though they knew it would be a challenging proposition for most surgeons and physicians to accept. The proposed and counterintuitive mechanism of action is that bleeding from the aorta spontaneously decompresses into a corresponding hole the physician makes in the vein, because the surrounding area behind the peritoneum has higher pressure than the vein.

Aortic Stenosis Risk Doubled by Family History
It is well-known among clinicians that aortic stenosis is the most common heart valve disease in the elderly and is often caused by calcification of a normal valve.

The results of the research, which were independently confirmed by a committee of outside cardiologists, show the procedure not only has a high success rate, but also an acceptable rate of bleeding and vascular complications, particularly in the high risk patients studied.

The study builds on the access technique that Lederman's NHLBI team developed and first tested in animals in 2012 and first applied with Henry Ford physicians to help patients in 2013. NHLBI and its collaborators are now working to find ways to train more specialists to perform the procedure.

Source-Eurekalert