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Heart Disease – Transcatheter Aortic Valve Replacement

February 3, 2021


“When we talk about innovation in heart disease, one of the greatest innovation that has come along in the last decade is the development of the transcatheter valve replacement. Now, if you had valve disease 10 years ago, 15 years ago, your only option was to have a sternotomy, where we cut your sternum open and then replaced the valve. But over the last decade, what we’ve developed is ability to be able to deliver a valve with a heart beating through a femoral approach or various other approaches when the femoral approach is not easy, buildup of plaque, et cetera. And we can implant a valve like this in the heart without cutting the body. Patients that get a transcatheter valve have left the hospital as early as the first day, post-procedure. And the majority of the patients that we do now are done with them under conscious sedation, where they’re not even under anesthesia with a complete knockout, they’re actually sedated such whether you don’t feel any of the procedure.

And they’re awakened very quickly after the procedure and ambulatory such that they can leave the hospital within 24 to 48 hours for the majority. When we first did these procedures, we could only do them on patients that were not a candidate for surgery, meaning a very old, debilitated patient that still had the zest for life, but couldn’t take a surgical procedure because of their comorbidities. And we showed reasonably good data. As we studied this further, we were able to show that in the high-risk surgical patient, we could have outcomes comparable to surgical valve replacement in terms of the survival and the need for pacemakers and the stroke rates. We studied it further and we found that in patients that were moderate surgical risk, we could give equivalent benefit. And then obviously within the last two years, we now have data that even in the low-risk younger patient, this is a viable option with improved outcomes.

So today, if you’re a patient that need a valve replacement for the aortic valve, you can get a transcatheter aortic valve replacement, whether you’re low-risk, high-risk or even prohibitive risk for open-heart surgery. And the technology is being advanced such that we’re now working on the fourth generation of valves, and they are much easier and much lower profile to deploy than they were from the original cohorts. So that’s why the complication rates are less. We have less stroke rates we have less bleeding risk, we have less vascular access complication, and we have shorter hospital stays. And whenever we offer a patient this option of a surgical valve versus a transcatheter valve, when they hear about the fact that they don’t have to have their chest sawed open, they usually prefer the transcatheter valve. We often educate them that because this is a newer technology, we don’t have the long-term data such that the surgical valves do. So to be fair and balanced, we often wonder if the durability of this valve is as long as the surgical valve, but that’s far what we’re learning is that the patient’s doing just as well with the transcatheter valve as they did with the surgical valve.”

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