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8/2/2019 Week 10 Health
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Question: Mycardiologist says I have aortic steno-
sis and need a newaortic valve. Healso mentionedthat the FDA hasapproved a new
rocedure that re-laces the aortic
valve without open-heart surgery.This option soundssafer to me, but mydoctor says this
new option is not or everyone. Canyou walk methrough the prosand cons of thesetwo approaches?
Answer: Theshort answer mayseem facetious: Ask your doctors. Infact, it's a compli-cated decision thatrequires an indi-
vidualized answerdepending on yourhealth, your prefer-ences and -- aboveall -- the experienceand skill of yourcardiac care team.With that said, let'sdiscuss some gen-eral considerations.
The aortic valveis a three-flapped
structure that en-sures the one-wayflow of blood fromthe heart's mainpumping chamberto the rest of the
ody. In some peo-ple, the aortic valve
ecomes encrustedwith calcium de-posits that stiffenand narrow it, re-stricting blood
flow.When people
with aortic stenosisstart feeling symp-toms such as light-headedness orfainting, breath-lessness, fatigueand loss of ap-petite, quality of life goes downhillquickly until the
valve is replaced.Until recently, re-placing the aortic
valve requiredopen-heart surgery.Now that the FDA
has approved a no-surgery techniquefor replacing afailed aortic valve,many people withaortic stenosis areasking, "Can I getthis procedure?"
The answeris "Maybe." That's
because the FDAhas currently re-
stricted its use topeople who are notgood candidatesfor open-heart sur-gery.
As you point out,it's easy to see whypeople might pre-fer the new ap-proach, calledtranscatheter aorticvalve implantation,or TAVI. The new
valve is placedusing a wire, orcatheter, that is ma-neuvered into theheart from a bloodvessel in the groin.Both the hospitalstay and recoveryare shorter and lesspainful than withopen-heart surgery.
The FDA based
its approval on aclinical trialdubbed PARTNER.In this trial, 69 per-cent of the patientsundergoing TAVIwere alive after ayear, comparedwith 50 percent of agroup that receivedstandard therapy,which included
balloon valvulo-
plasty, an attemptto increase thevalve opening witha balloon-tippedcatheter.
PARTNER datapresented at a sci-entific meeting inlate 2011 showedthat more thantwo-thirds of thepeople in the stan-
dard-care grouphad died after twoyears, compared
with 43 percent inthe TAVI group.Another analysisfound that quality-of-life scores afterone year amongthe TAVI group im-proved by 32points on a 100-point scale, whilescores among the
s t a n d a r d - c a r egroup improved byonly 4 points.
But although itprolongs life and isless invasive thanopen-heart surgery,TAVI has its draw-
backs. TAVI recipi-ents in thePARTNER trial hadmore than twice
the number of strokes and manymore serious
bleeding complica-tions than patientsin the other group.The bleeding prob-lems were mostlyrelated to the widecatheter that's usedduring TAVI.
So it's importantto look at the bene-
fits and drawbacksof TAVI on an indi-
vidual basis, taking
into account yourspecific health sta-tus. That's where
your heart teamcan be very usefulin advising you.People who aretreated with TAVImay live longerthan patients whoundergo standardtherapy, but theprocedure doeshave limitationsthat need to be con-
sidered, too.The FDA stipu-lates that a surgeonmust help deter-mine which peoplewith aortic stenosisare eligible forTAVI. Patients may
be eligible becausethey have an un-
healthy aorta (themain pipeline for
blood from th
heart to the body),chest tissue thatwon't heal well dueto past radiationtreatment, previ-ous artery-bypasssurgery that makesanother surgeryimpractical or sim-ply a very weak heart.
The TAVI proce-
dure is an primeexample of as-tounding medicalinnovation. But itstill takes old-fash-ioned experienceand judgment todecide when to usethis new technol-ogy.
OUR GOOD HEALTH
2 Rubin Dr., Rushville Open Mon.-Sat.
Expanded Hours for your convenience:
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Call 585-554-4400 to schedule an appointment.
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No-surgery option for aortic stenosis is not for everyoneBy the faculty of Harvard Medical School
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Copyright 2012 the President and Fellows of HarvardCollege. Developed by Harvard Health Publications
(www.health.harvard.edu).Distributed by Universal Uclick for UFS. Submiquestions to harvard_adviser@hms. harvard.edu.
Chronicle-Express.com • The Chronicle-Express • Wednesday, March 7, 2012 B5