Transcatheter Aortic Valve Replacement

 

Aortic valve replacement continues to be rejected in patients over 75 years of age and who have severe cases of aortic stenosis. This procedure is considered far too risky, with poor health outcomes (Rozeik et al., 2014). However, technological advancements have made it possible to revolutionize the placement of an aortic valve, which is generally performed under open heart surgery, to a less invasive procedure. The transcatheter aortic valve replacement (TAVR) procedure allows for a valve to be placed percutaneously and makes it possible to avoid open heart surgery altogether (AHA, 2014). Similarly to stent placement, TAVR replaces the old valve through a catheter without having to remove the old one (AHA, 2014). Once the new valve  expands, it pushes the old leaflets out of the way and begins to take over as follows:

Although the procedure is currently only FDA approved to use in high risk patients with severe aortic stenosis, it is incredible to know that there is now a solution for those who were previously denied treatment. Technological advancements continue to revolutionize both the science and art of medicine. Although the procedure is not free of possible complications, it does have a shorter recovery period (3-5 days) as compared to the alternative open heart surgery (AHA, 2014). In one case, a high risk patient with severe aortic stenosis previously turned down by a multitude of surgeons underwent TAVR and immediately saw a transvalvular pressure gradient decrease of 24 mm Hg and a 3% improvement in ejection fraction indicating promising outcomes (Rozeik et al., 2014). Although this procedure continues to be performed in selective facilities, it is promising to know that one of our own local community hospitals, Los Robles Hospital and Medical Center, is currently pioneering it (Los Robles Hospital). I look forward to witnessing and taking part in the revolution of medicine that technology has allowed us to have!

References:
Rozeik, M.M., Wheatly, D.J., Gourlay, T. (2014). The aortic valve: structure, complications and implicationsfor transcatheter aortic valve replacement. Perfusion, 29 (4), 285-300.

American Heart Association. (2014). Retrieved from http://www.heart.org/HEARTORG/Conditions/More/HeartValveProblemsandDisease/What-is-TAVR_UCM_450827_Article.jsp

Los Robles Hospital. Retrieved from http://losrobleshospital.com/service/transcatheter-aortic-valve-replacement-procedure