Recent high-profile “rock star” media coverage has piqued public interest in a minimally invasive cardiac procedure, known as transcatheter aortic valve replacement (TAVR) – referred to as transcatheter aortic valve implantation (TAVI) in Europe and Asia – used to treat aortic stenosis (AS), one of the most common heart valve diseases.
AS happens when the heart’s aortic valve narrows, preventing the valve from fully opening. This reduces or blocks blood flow from the heart into the main aorta, and on to the rest of the body. When this happens, the heart must work harder to pump blood around the body. This can lead to symptoms such as lightheadedness, shortness of breath or chest pain. Ultimately, if left untreated, AS can be fatal.
AS has traditionally been treated with open-heart surgery with surgical aortic valve replacement (SAVR), a major operation that involves the surgeon opening the chest to access the heart. The procedure can take up to six hours and typically requires a hospital stay of a week or more, with a prolonged recovery time.
First performed in 2002 in a 57-year-old inoperable patient with AS, with TAVR the interventional physician inserts the replacement heart valve, most commonly through a small access site in the patient’s upper thigh. Using advanced x-ray and ultrasound imaging, which is why we call this “image-guided,” the valve is precisely guided to the heart and deployed at the site of the old failing valve. TAVR can be carried out in as little as 90 minutes and most commonly only requires mild sedation, typically avoiding the need for general anesthesia and intubation.
TAVR had been typically performed in patients who were so elderly or unwell that they faced the risk of not surviving open heart surgery. However, recent findings from two clinical trials showed that TAVR was just as useful in younger, healthier patients and may even be more effective.
Presented at the American College of Cardiology (ACC) Meetings earlier this year, both the PARTNER 3 Trial and the CoreValve Low-Risk Trial were conducted on patients who were deemed low-risk surgical candidates, not the usual profile of a patient undergoing TAVR.
Both trials showed notable benefits of TAVR compared to SAVR, including reduced risks of stroke, death and repeat hospital admissions.
It’s not just the patient who benefits – lengthy hospital stays as seen with open-heart surgery can be dramatically reduced, alleviating pressure on hospital resources. It’s likely that wider use of TAVR will result in a corresponding decrease in waiting times for treatments.
The result? Increased satisfaction all round.
Physicians and patients are optimistic that the FDA is anticipated to approve the procedure for lower-risk patients later this year. That would be particularly encouraging news – one study found that nearly two thirds of patients with severe AS do not receive the appropriate treatment.
I’m thrilled to see “rock-star” publicity bring awareness to image-guided therapy innovations like TAVR, which will help get more people back to living the lives they love and doing the things they enjoy.
Chief Medical Officer, Image Guided Therapy
Atul Gupta, MD is a practicing interventional radiologist and Chief Medical Officer at Philips’ Image Guided Therapy business cluster. Prior to joining Philips in 2016, Atul served on Philips’ International Medical Advisory Board for more than 10 years.
Atul continues to perform both interventional and diagnostic radiology in suburban Philadelphia, in both hospital and office-based lab settings. He has been repeatedly recognized as top physician for his specialty in the media and serves on several advisory boards. He has also published and lectured internationally on a range of interventional procedures.
February 10, 2020
December 13, 2019
