The FDA recently approved the transcatheter aortic valve replacement (TAVR) for patients with intermediate risk. We spoke with experts in the Jefferson Angioplasty Center to find out what this means for patients with aortic valve stenosis. Interventional Cardiologist Dr. Nicholas Ruggerio performs TAVR procedures and Nurse Practitioner Rebecca Marcantuono coordinates Jefferson’s TAVR program.
What is aortic valve stenosis and who is at risk for this condition?
Ms. Marcantuono: Aortic valve stenosis is the narrowing of the heart valve that allows blood to exit the heart and flow into the body. It is a common diagnosis, affecting more than six million people worldwide. The most common risk factor is age, with most people being diagnosed in their 80’s.
What causes it and what are the symptoms?
Ms. Marcantuono: Aortic stenosis usually happens slowly over a lifetime. The precise mechanism isn’t known, but some recent studies suggest that inflammation could play a role. Common symptoms include chest pain, feeling short of breath with activities previously completed with ease, difficulty walking long distances or up steps, and having episodes of feeling dizzy or lightheaded.
How is aortic valve stenosis treated?
Dr. Ruggiero: Medications can be used to improve the symptoms; however, the only treatment for correction of the narrowing in an aortic valve is replacement. This replacement can be done through open heart surgery or through a catheter. Each has advantages, so patients should talk with their doctor about what is best for them.
Last week, the FDA approved the transcatheter aortic valve replacement (TAVR) for patients with “intermediate risk.” What does this mean for patients?
Dr. Ruggiero: When a patient is evaluated for aortic stenosis treatment, there is a calculation used to determine how risky traditional open heart operation would be. In the recent past, that risk had to be significant to qualify a patient for TAVR. With the new FDA expanded approval for “intermediate risk” this will give patients the option to receive TAVR when previously the only option for valve replacement would have been traditional open surgery. The FDA estimates that one third of patients who are referred for open heart aortic valve replacement fall into the intermediate risk category.
What is recovery from a TAVR procedure like?
Dr. Ruggiero: With TAVR, we do not open the ribs to access the heart. Instead, we use a catheter, which is threaded through a large blood vessel through a small incision in the groin. I tell my patients they can expect a four day hospital stay. Within two weeks of the procedure, most patients are back to their daily routines without limitations.
Can patients choose whether they want a TAVR or open heart surgery?
Dr. Ruggiero: The goal of Jefferson’s TAVR program is to improve quality of life for each patient affected by this disease. We use a team-based approach, with experienced providers, who help identify the treatment plan that is right for you. We offer multiple anesthesia options which help to promote early recovery and an early discharge program. You are our partner in care which means your opinion is part of the decision-making process.
Read about Joyce’s experience with Jefferson’s TAVR Program.