New heart procedure could help older, frail patients

Non-surgical technique to treat aortic stenosis

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Richard Pierce is a retired brigadier general and he's a heart patient.  He spends his time collecting uniforms from around the world and reenacts major events and speeches.

"America has never lost, nor will lose a war," Pierce said quoting General Patton.

General Patton's famous speech has set the stage for Pierce's war against his own hert.

"I've had everything done to me that can be done except a pacemaker and a new ticker," explained Pierce.

His latest battle: aortic stenosis.  It's a narrowing of the aortic valve.

"The prognosis of aortic stenosis is worse than some cancers," said Dr. Raj Makkar, Interventional Cardiologist at Cedars-Sinai Medical Center in Los Angeles.

Traditionally, the only fix would be open heart surgery.  But thousands of patients like Pierce would be too old, too frail or too sick to survive it.

"The majority of people would be dead in five years or less," said Makkar.

Interventional Cardiologists at Cedars-Sinai Heart Institute are using a non-surgical technique, involving placing a valve inside a catheter that's snaked up the patient's body through the groin.  Once inside, a balloon pops the valve open.  Recovery time is cut from weeks to just days.

Results published in the New England Journal of Medicine show death after two years for Transcatherter Aortic Valve Replacement was 43 percent.  Compare that to standard open heart surgery at 68 percent.

A study between open heart patients and Transcatheter patients showed two years after the procedures, there were similar outcomes for survival and stroke.  Right now, the non-surgical technique is being used only for patients who are not good candidates for the traditional open heart surgery - such as frail, older people who would not survive.  But clinical trials began this year for people who are less frail.

Additional Information:

AORTIC VALVE STENOSIS:  Aortic valve stenosis (AS) is a heart disease caused by the incomplete opening of the aortic valve in the heart. The aortic valve controls the direction of blood flow from the left ventricle (chamber of the heart) to the aorta (the major blood vessel the supplies blood to the whole body). Under some circumstances, the aortic valve becomes narrower than normal, impeding the flow of blood. This is known as aortic valve stenosis, or aortic stenosis. The more constricted the valve, the more the blood flow is impeded. This can cause life-threatening impairment of heart function. Medications and balloon valve angioplasty (inflating a balloon in the valve to increase the opening) can provide some relief of AS, but aortic valve replacement (AVR) is the only effective treatment in adults with severe symptomatic aortic stenosis to improve long-term survival. AVR surgery is a major open-chest procedure that carries significant risk for any patient. For some patients the risk is greater due to their age or other additional medical conditions, the risk is too great to undergo surgery. (Source:

RISK FACTOR:  Aortic valve stenosis isn't considered preventable. Some risk factors include:

  • A deformed aortic valve:  Some people are born with an already narrowed aortic valve or develop aortic valve stenosis later in life because they were born with a bicuspid aortic valve — one with two flaps (leaflets) instead of three. A bicuspid aortic valve is a major risk factor for aortic valve stenosis. A bicuspid aortic valve can run in families, so knowing your family history is important. If you have a first-degree relative — a parent, sibling or child — with a bicuspid aortic valve, it is reasonable to check to see if you have this abnormality.
  • Age:  Aortic valve stenosis may be related to increasing age and the buildup of calcium deposits on heart valves.
  • Previous rheumatic fever: Rheumatic fever can cause the flaps (leaflets) of your aortic valve to stiffen and fuse, eventually resulting in aortic valve stenosis. ( Source: CNN Health)

OPERATION: FIX MY HEART - For patients who have been deemed inoperable for traditional open-heart surgery by a surgeon, a new procedure called transcatheter aortic valve replacement is now available as a treatment option. In November of 2011, the Food and Drug Administration (FDA) approved the Edwards SAPIEN Transcatheter Heart Valve for the treatment of patients with severe symptomatic native aortic valve stenosis who have been determined by a cardiac surgeon to be inoperable for open aortic valve replacement and in whom existing co-morbidities would not preclude the expected benefit from correction of the aortic stenosis. This new transcatheter procedure allows the diseased native heart valve to be replaced without open-heart surgery. (Source: Robert Wood Johnson University Hospital)

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