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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.

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Chronicle-Express.com • The Chronicle-Express • Wednesday, March 7, 2012 B5