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TAVR: Transcatheter Aortic Valve Replacement

Monday, December 9, 2013
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The Cutting-Edge Procedure That Is Saving Lives with Dr. Mark Anderson, Einstein Institute for Heart and Vascular Health, Chairman, Regional Cardiothoracic Surgery Division

In layman’s terms, what is transcatheter aortic valve replacement?

“In this new technique we use a catheter to introduce a stent across the aortic valve and that stent is embedded with a new valve,” explains Dr. Mark Anderson. “This replaces the existing, malfunctioning one. The stent is like those for coronary arteries, but much bigger. It’s a stent on steroids. Its diameter is over 20 millimeters where the diameter for a coronary artery may only be 2 or 3 millimeters.”

 

Putting the stent in place in the aorta pushes aside the old valve. The stent anchors itself to that valve, providing a solid foundation for it. “Once we deploy the stent, the valve opens like a parachute,” Anderson explains. “This is cutting-edge technology and represents a minimally-invasive procedure. Patients are usually released from the hospital within a day or two.”

Will TAVR replace surgical valve replacements?

No, Anderson says, or at least not yet. “We don’t do this for everyone for several reasons, beginning with the fact that we’re not sure of the durability of the valve,” Anderson says. “We have a lot of data on the surgical valves and know that they can last up to 20 years.  We are not sure how long these new valves will last.  Also, the cost of the new valves is currently 10 times that of surgical valves.  This creates a significant medical economic issue.”

What are the risks of TAVR?

“This procedure does have its own subset of potential complications,” Anderson says. “When you balloon open the old valve and push it away, you can get calcium fragments in the blood stream. So there is a stroke risk, which may be 5 times that of the risk for stroke with surgical valve replacement. There is also the possibility of vascular complications from placing the relatively large catheter in a diseased vascular system.   Also, as the old valve is left in place, the new valve may not deploy or open correctly resulting in malposition or incompetence.  This is a potentially serious situation.  If this happens, there are techniques to remedy the situation but it can result in the need for emergency surgery.”

Who is a candidate for TAVR?

Anderson explains that, right now, TAVR is reserved for older patients or patients who are poor surgical candidates with aortic stenosis. “These patients are generally in their 70s through 90s and are more challenging to operate on because they can be quite frail,” he says. “Usually, they have other pre-existing medical conditions and don’t tolerate invasive procedures well.  So, despite the risks of this procedure, it is a better option for them than surgery. The bottom line is that to be candidates, patients have to have a good reason not to undergo traditional surgery.”

What is the evaluation process?

Patients are seen by a multidisciplinary team at Einstein’s valvular heart disease clinic. Interventional cardiologists and surgeons collaborate to get the best assessment of each patient’s condition and prognosis. Potential candidates get a sophisticated work-up including CAT scans so physicians can see the anatomy of the heart and its vascular tree, and get as much information as possible about whether a patient is a candidate and how to install the valve. 

For more information about Einstein’s TAVR, visit http://www.einstein.edu/cardiology-heart/transcatheter-aortic-valve-replacement.

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