Week 10 Health
2
Question: My cardiologist says I have aortic steno- sis and need a new aortic valve. He also mentioned that the FDA has approved a new rocedure that re- laces the aortic valve without open-heart surgery. This option sounds safer to me, but my doctor says this new option is not or everyone. Can you walk me through the pros and cons of these two approaches? Answer: The short answer may seem facetious: Ask your doctors. In fact, it's a compli- cated decision that requires an indi- vidualized answer depending on your health, your prefer- ences and -- above all -- the experience and skill of your cardiac care team. With that said, let's discuss some gen- eral considerations. The aortic valve is a three-flapped structure that en- sures the one-way flow of blood from the heart's main pumping chamber to the rest of the ody. In some peo- ple, the aortic valve ecomes encrusted with calcium de- posits that stiffen and narrow it, re- stricting blood flow. When people with aortic stenosis start feeling symp- toms such as light- headedness or fainting, breath- lessness, fatigue and loss of ap- petite, quality of valve required open-heart surgery. Now that the FDA has approved a no- surgery technique for replacing a failed aortic valve, many people with aortic stenosis are asking, "Can I get this procedure?" The answer is "Maybe." That's because the FDA has currently re- stricted its use to people who are not good candidates for open-heart sur- gery. As you point out, it's easy to see why people might pre- fer the new ap- proach, called transcatheter aortic valve implantation, or TAVI. The new valve is placed using a wire, or catheter, that is ma- neuvered into the heart from a blood vessel in the groin. Both the hospital stay and recovery are shorter and less painful than with open-heart surgery. The FDA based its approval on a clinical trial dubbed PARTNER. In this trial, 69 per- cent of the patients undergoing TAVI were alive after a year, compared with 50 percent of a group that received standard therapy, which included balloon valvulo- plasty, an attempt to increase the valve opening with a balloon-tipped catheter. PARTNER data presented at a sci- entific meeting in late 2011 showed that more than with 43 percent in the TAVI group. Another analysis found that quality- of-life scores after one year among the TA VI group im- proved by 32 points on a 100- point scale, while scores among the standard-care group improved by only 4 points. But although it prolongs life and is less invasive than open-heart surgery, TAVI has its draw- backs. TAVI recipi- ents in the PARTNER trial had more than twice the number of strokes and many more serious bleeding complica- tions than patients in the other group. The bleeding prob- lems were mostly related to the wide catheter that's used during TAVI. vidual basis, taking into account your specific health sta- tus. That's where your heart team can be very useful in advising you. People who are treated with TAVI may live longer than patients who undergo standard therapy, but the procedure does have limitations that need to be con- sidered, too. The FDA stipu- lates that a surgeon must help deter- mine which people with aortic stenosis are eligible for TA VI. Patients may be eligible because they have an un- healthy aorta (the main pipeline for blood from the heart to the body), chest tissue that won't heal well due to past radiation treatment, previ- ous artery-bypass surgery that makes another surgery impractical or sim- ply a very weak heart. The TAVI proce- dure is an prime example of as- tounding medical innovation. But it still takes old-fash- ioned experience and judgment to decide when to use this new technol- ogy. OUR GOOD HEALTH 2 Rubin Dr., Rushville Open Mon.-Sat. Expanded Hours for your convenience: Mon-Thurs 7:30am-7pm; Fri 7:30am-5pm; Sat. 8am-12pm Call 585-554-4400 to schedule an appointment. Currently accepting new Medical and Dental patients. Accepting all insurances, including Medicaid & Medicare. Sliding fee discounts available to qualifying patients with no, or limited, insurance. No-surgery option for aortic stenosis is not for everyone By the faculty of Harvard Medical School Copyright 2012 the President and Fellows of Harvard College. Developed by Harvard Health Publications (www.health.harvard.edu). Distributed by Universal Uclick for UFS. Submi questions to harvard_adviser@hms. harvard.edu. Chronicle-Express.com • The Chronicle-Expr ess • We dnesday , Mar ch 7 , 201 2 B5
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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:
Mon-Thurs 7:30am-7pm; Fri 7:30am-5pm; Sat. 8am-12pm
Call 585-554-4400 to schedule an appointment.
Currently accepting new Medical and Dental patients.
Accepting all insurances, including Medicaid &
Medicare. Sliding fee discounts available to
qualifying patients with no, or limited, insurance.
No-surgery option for aortic stenosis is not for everyoneBy the faculty of Harvard Medical School
Available for Emergencies, Consultations
and All Your Dental NeedsMastercard
& Visa Accepted
“ON THE VILLAGE SQUARE” Hammondsport
SAM PENNISE, DMD As Always, Accepting New Patients!
Appointments Available Daily
Office…28 Mechanic St.,Hammondsport 607-569-2242
Res.…Hammondsport…607-569-2143
Water Street Pharmacy, Inc. 14 Water Street
Dundee, NY 14837
607-243-8114
One Hour Photo Lab
Professional Healthcare Hometown Hospitality
Tracey L. Knapp, RPh President
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
