Dx Dialogues: What are the treatment options for aortic stenosis?

Many patients will do very well with open heart surgery. But initially there were patients who were too old and too sick for surgical aortic valve replacement (SAVR), so there was the development of a transcatheter aortic valve replacement (TAVR).

Transcript

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Many patients will do very well with open-heart surgery. But initially, there were patients who were too old and too sick for SAVR.

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And so there was the development of a transcatheter aortic valve replacement or TAVR.

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Hi, I am Kendra Grubb. I am the surgical director of the Structural Heart and Valve Center at Emory University.

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I am an adult cardiac surgeon, which means that, by the combination of those two titles, I do traditional open-heart surgery

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as well as the newer technologies using catheters and wires in order to implant new valves in the heart

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without opening the breastbone. For aortic stenosis, there are really three ways that the valve can be addressed.

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There are no medical therapies to stop the progression. But we can treat the symptoms. So in patients who are elderly and frail

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and really have a life expectancy of maybe less than one year, those patients are going to be initiated on guideline-directed medical

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therapy to really address their symptoms. How can we make these patients feel better? Those same medications are going to be

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the basis of treatment for all patients with aortic stenosis. But for patients who are expected to live longer

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and who would benefit from therapy, the mechanical obstruction requires a mechanical solution.

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Traditionally, this required open-heart surgery, surgical aortic valve replacement or SAVR,

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in which the patient would be under general anesthesia. We would open the breastbone. We would go on the heart-and-lung machine

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and bypass the heart and lungs, and then be able to open the aorta and replace the valve,

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literally cut out the valve and sew a new valve in. Many patients will do very well with open-heart surgery.

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But initially, there were patients who were too old and too sick for SAVR.

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And so there was the development of a transcatheter aortic valve replacement or TAVR.

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For these patients, we're able to make a small puncture in the groin, enter the anatomy the same way that blood gets

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to the legs, go backwards through the aorta to the heart valve, put a wire across the valve,

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push the old valve out of the way, and the new valve takes over. Now, here we have not removed the old, calcified leaflets.

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We're just pushing them to a side. Initially, TAVR was reserved for high-risk or inoperable

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patients. And over the last decade or so, we have studied TAVR versus SAVR in intermediate-risk and now

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low-risk patients, with approval for low-risk patients who are 65 years or older for TAVR or SAVR.

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For these patients, as far as we know-- we're only out about five years with the data. But as far as we know, the results

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are very similar, surgery versus TAVR, even in patients as young as 65. [MUSIC PLAYING]