Heart Repair That’s Easier on Older Bodies

Aortic valve treatment in elderly can be less invasive with catheter method

(RxWiki News) As more people live beyond 80, incidences of heart valve blockages have grown. Damaged aortic valves are often treated surgically, but a catheter-based method has emerged as an alternative.

Aortic stenosis is a condition where the main valve in the aorta, the large artery carrying blood out of the heart, does not open fully. Through a relatively new procedure called transcatheter aortic valve implantation (TAVI), the valve can be replaced without removing the damaged aortic valve. A new valve is inserted at the site through a catheter (flexible tube) fed through a blood vessel.

Compared to surgery, this minimally invasive method may be equally successful and less taxing for elderly patients, according to a new study.

"Ask your doctor about all your options for heart valve replacement."

Mansanori Yamamoto, MD, and Emmanuel Teiger, MD, both from the Centre Hospitalier Universitaire (CHU)-Henri Mondor in Creteil, France, led this study of 2,254 patients age 80 years and older who underwent TAVI.

As individuals age, heart valves may accumulate deposits of calcium, which can stiffen valve leaflets and narrow the valve.

Until recently, open heart surgery has been the only way to replace the valve. Surgical aortic valve replacement (SAVR), however, can put great strain on older bodies and recovery can be slow.

With the TAVI method, doctors make a small incision to access a blood vessel, rather than cutting through chest bones. A catheter is then directed to the site of aortic damage where a collapsible replacement valve is positioned and expanded. The old leaflets are pushed away, and the tissue in the replacement valve takes over and begins controlling the blood flow, according to the American Heart Association.

“Our study found TAVI to provide acceptable clinical results in very elderly populations,” said Dr. Yamamoto in a statement. “Elderly patients generally require more time to recover after invasive treatments [such as aortic valve replacement surgery] so TAVI may have advantages because earlier mobility plays a significant role in maintaining neuromuscular strength and physical function in elderly patients. Smaller incisions allow faster resumption of physical activity and therefore full recovery.”

In this investigation, subjects — who had the procedure between January 2010 and October 2011 at French hospitals — were divided into three age categories for analysis: 80- to 84-year-olds (867 patients), 85- to 89-year-olds (1,064 patients) and those 90 years old or older (349 patients).

The authors of this study noted that the TAVI procedure had a very high success rate among all groups, ranging from 96 percent to 98 percent.

At 30 days, the mortality rate among all age groups was at about 10 percent and rose to about 24 percent a year after surgery.

The researchers remarked that, considering the age of the patients and other possible causes of death at this age, mortality rates in patients at least 80 years old were “acceptable.”

“Transcatheter aortic valve implantation may be a good therapeutic option even in very elderly patients [85 to 89 years old and 90 years old or more],” concluded the authors.

"Severe stenosis, or narrowing, of the aortic valve is more common later in life, because the process often worsens over the course of many years," said Sarah Samaan, MD, cardiologist and physician partner at the Baylor Heart Hospital in Plano, Texas.

"There is no medical treatment for the condition, and open heart surgery can be risky in the very elderly, especially for those with other serious health problems. In the past, people considered to be high risk for surgery had few options. Since severe aortic stenosis may cause shortness of breath or dizziness with even mild activity, it can have a major impact on quality of life and may shorten life considerably," Dr. Samaan told dailyRx News.

"Although open heart surgery for valve replacement is still the gold standard, it's good news that we now have another option for improving heart valve function in people for whom the risk of surgery is unacceptably high," she said.

This investigation, however, did not directly compare results of those who received TAVI with equivalent patients who had surgical treatment.

“Thus, this study cannot definitively conclude that TAVI is superior to SAVR even in very elderly populations,” wrote the authors.

This study was published in the January 2014 issue of The Annals of Thoracic Surgery. The research was supported by Edwards Lifesciences and Medtronic.

Review Date: 
January 7, 2014