TAVR Procedure Safe for Elderly with Aortic Stenosis
TAVR is the latest advance in aortic valve replacement; its minimally invasive approach means patients who previously were out of options now have an effective, safe choice for treatment.
High-risk patients with severe narrowing of the aorta are no longer out of options – even if they’re in their 90s.
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A recent Cleveland Clinic Heart and Vascular Institute study confirms that Transcatheter aortic valve replacement (TAVR) is now safe and effective for patients well into their 80s and 90s.
The key to successful results with this minimally invasive procedure is an experienced medical and support team working in a comprehensive large medical center, with the ability to manage risk and complications.
Samir Kapadia, MD, Director of the Sones Cardiac Catheterization Laboratories and Director of the Interventional Cardiology Fellowship Program at Cleveland Clinic, reported in a recent study with other colleagues that reviewed results from transfemoral, or TF- TAVR, procedures done at Cleveland Clinic from 2006 to 2012. The results appear in Catheterization And Cardiovascular Interventions.
The researchers found that the procedure had a 95.7 percent success rate in attempted TF-TAVR. Thirty-day mortality was low, (.4 percent) and stroke rate was 1.6 percent. At a one-year follow up completed in 76 percent of patients, mortality was 17.5 percent and stroke rate was 3.5 percent.
Dr. Kapadia says these results are important. “Transcatheter aortic valve replacement has matured.”
Aortas are lifelines – the channel for blood to the body and brain. Aortic stenosis (narrowing of the aorta) restricts vital blood flow. Diseased valves can also make blood leak backwards into the heart.
As aortic stenosis progresses, patients experience fatigue and shortness of breath, among other symptoms.
Surgical aortic valve replacement can be too tough on the body when patients have multiple comorbidities. In TF-TAVR, the valve is passed through the femoral artery in the leg up to the aorta.
Surgeons and interventional cardiologists use detailed digital imaging to help them see the aorta and surrounding anatomy.
Nonagenarians Raymond and Mazie Huggins successfully underwent TAVR on the same day at Cleveland Clinic’s Heart And Vascular Institute after they both had symptoms of advanced aortic stenosis.
“When they came to us, they were very short of breath and had medical problems that were unbelievably complex,” says Dr. Kapadia. “A normal aortic opening is about 2.5 cm. But theirs were closed down to 0.3 and 0.4 — about 10 times smaller.”
They aren’t the oldest TAVR patients, but they are the first married couple to undergo the procedure the same day, says Dr. Kapadia.
The Hugginses were fortunate that science kept up with their medical needs. “Five or 10 years ago, nothing could have been done for them. We would have had to stop the heart and open up the chest, and at that age the recovery would be up to two months, with significant risk,” Dr. Kapadia says.
The couple was able to return to their home following their same-day, dual TAVR procedures. They both recovered in time to celebrate their 75th Wedding Anniversary in October of 2015.
The next step forward for TAVR will be to offer moderate risk patients a safer, less invasive option to traditional surgery. “We are excited not only that we can now offer hope to our extremely high risk patients; we are looking forward to the possibility of recommending this less invasive treatment for operable high and even moderate risk patients as well,” Dr. Kapadia says.
If you have aortic stenosis, talk with your doctor to discuss your options for treatment, including traditional and TAVR surgery.