Published on March 31, 2014

Introducing Transcathether Aortic Valve Replacement

Aortic valve disease, also known as aortic stenosis, takes the lives of more than 25,000 people each year. Many of these deaths might have been prevented, had there been an option for those deemed ineligible for open heart surgery or whose condition didn’t adequately respond to medication and medical therapy. Today, that option is here.

Introducing Transcatheter Aortic Valve Replacement, commonly known as TAVR. It’s a new medical technology that, in clinical trials, reduced mortality by 40 percent compared to conventional medical therapy. And Jacksonville’s Dr. Samer Garas, Interventional Cardiologist at St. Vincent’s HealthCare, is the first in Northeast Florida and among the first nationwide to offer it to area patients.

Aortic stenosis is a narrowing of the heart’s aortic valve opening, most often caused by age-related calcification but also potentially a result of a birth defect, rheumatic fever or radiation therapy. It inhibits the normal blood flow. As a result, blood that eventually flows from the lungs to the brain and other parts of the body contains less oxygen, a critical component for a healthy body. Symptoms may include severe shortness of breath, extreme chronic fatigue, lightheadedness and heart palpitations. Or, patients may show no discernable symptoms at all.

Before FDA approval of TAVR, an otherwise healthy patient who didn’t respond to medication faced open heart surgery to treat aortic stenosis, which affects up to seven percent of the population over the age of 65. That could mean upwards of 10 days in the hospital and weeks of rehab afterward. Those whose health and medical history deemed them inoperable, such as elderly patients and those with pulmonary disease or prior bypass surgeries, might simply be told that there was nothing further doctors could do for them. Half of those with symptoms died within two years.

News of TAVR first surfaced in the early 2000. A physician uses a catheter to percutaneously insert a bioprosthetic aortic valve (stent), implanting it in the orifice of a native aortic valve. The stent latches to the inner walls of the natural valve and widens the narrowed opening, allowing for normal blood flow. TAVR first was approved by the FDA in 2012 for inoperable patients. Last year, treatment eligibility was extended to high risk patients including those with pulmonary disease that would make open heart surgery problematic, and those who had previously undergone heart bypass surgery that would make opening the chest cavity difficult. Studies are underway and within the next five years, it’s expected that FDA officials will approve TAVR for standard risk patients, those who are between 60 to 70 years old, have never undergone bypass surgery, have no history of pulmonary disease and are otherwise healthy.

TAVR technology continues to progress. One anticipated advancement is the development of smaller stents that will allow for catheter delivery via the leg. Smaller delivery systems make for fewer complications and higher success rates, Dr. Garas said.

The best part: Being able to tell those previously untreatable patients that TAVR offers new hope.

“It’s fantastic,” Dr. Garas says. “There are lots of advancements and new technologies in our specialty. That makes it very difficult when there’s nothing we can do for a patient. It’s definitely a good feeling to be able to give them another option now, rather than telling them they’ll have shorter breath and be uncomfortable for the rest of their lives. TAVR improves quality of life and reduces mortality.”