Minimally Invasive Valve Replacement May be as Effective as Open-Heart Surgery for Some Patients
Northwestern Memorial Hospital is one of the region’s highest-enrolling centers participating in a clinical research trial evaluating the effectiveness of a minimally invasive procedure for heart valve replacement for patients suffering from aortic stenosis, a narrowing of the heart valve. Interim study results presented at the American College of Cardiology conference suggest an approach known as transcatheter aortic valve replacement (TAVR) may be a viable option for patients who are not candidates for traditional open-heart surgery to replace the aortic valve. The trial, called Placement of AoRtic TraNscathetER Valves, or PARTNER, compared TAVR to open-heart surgery and found that subjects who underwent TAVR surgery had the same survival rate one-year post procedure as those who underwent open-heart surgery. Experts say this is historic news for patients who cannot tolerate open-heart surgery due to age or frailty.
“While surgery still remains a viable therapeutic course for many patients, some are simply too weak for traditional open-heart methods,” says Charles J. Davidson, MD, interventional cardiologist, chief of the cardiac catheterization lab at Northwestern Memorial’s Bluhm Cardiovascular Institute, professor of medicine at Northwestern University Feinberg School of Medicine and co-principal investigator of the PARTNER trial at Northwestern. “What has happened, is they’ve had very limited options when it comes to valve replacement—and unfortunately many do not survive. The initial results from this ongoing study are very encouraging because they indicate that this catheter based replacement may be as safe and effective as open-heart surgery for this patient population.”
TAVR or open-heart surgery is provided to participants that suffer from aortic stenosis, a condition that causes the aortic valve to narrow, inhibiting the blood flow from the heart. Over time, aortic stenosis can cause heart failure. Northwestern’s Bluhm Cardiovascular Institute is one of 26 centers in the country to participate in the PARTNER trial, which has enrolled 699 subjects at the time of interim data analysis who were randomly assigned to either TAVR or open-heart surgery to replace the aortic valve. TAVR uses expandable stenting technology that allows insertion of the prosthetic valve while the heart is still beating, eliminating the need for cardiopulmonary bypass and its associated risks. The median age of subjects was 84 years.
“Traditional open-heart surgery can be risky for elderly patients or those with severe valve disease,” said S. Chris Malaisrie, MD, cardiac surgeon at the Bluhm Cardiovascular Institute and assistant professor of Surgery at Feinberg. “This procedure may provide an alternative option to address aortic stenosis and ultimately increase life expectancy for these patients.”
“Procedures like TAVR may represent the future of the standard of care for inoperable patients with severe aortic stenosis,” states Patrick M. McCarthy, MD, chief of Cardiac Surgery at Northwestern Memorial, director of the Bluhm Cardiovascular Institute and Heller-Sacks Professor of Surgery at Feinberg. “The findings of this trial demonstrate TAVR may be an acceptable alternative to traditional open-heart surgery in select, high-risk patients. It’s highly conceivable that future randomized studies will focus on offering TAVR to lower risk patients as well.”
For more information about the PARTNER trial or the Bluhm Cardiovascular Institute, visit www.heart.nmh.org.
Northwestern Memorial Hospital