When an aortic heart valve needs replacement, open-heart
surgery has been the go-to procedure to treat most patients.
Unfortunately, open-heart surgery is considered too risky
for some patients, especially the elderly, so they were often
left with few options. Until now.
Thanks to a new “game-changing” procedure called
transcatheter aortic valve replacement, high-risk surgical
patients now have a second chance.
This minimally invasive approach is providing
groundbreaking results for patients who have severe aortic
stenosis, a condition where the aortic heart valve does
not open wide enough to let adequate blood flow through.
The procedure, pioneered at the Washington University
and Barnes-Jewish Heart & Vascular Center, was approved
by the U.S. Food and Drug Administration in November 2011.
Through the procedure, physicians are able to replace aortic
valves without opening a patient’s chest. Instead, physicians
thread a catheter, mounted with a compressed replacement
valve on a tiny balloon, through an incision in a vein in the
groin. Once in position, a stent-like valve is inflated in the
aorta and the balloon and catheter are withdrawn. No major
incisions are involved and the heart is never stopped or put
on bypass. The average recovery time is much shorter than
for traditional surgical valve replacement and patients report
significantly less pain with the minimally invasive approach.
The transcatheter aortic valve replacement procedure
is considered a major breakthrough in the world of heartdisease
treatment. About 100,000 Americans over age 65
receive new aortic valves each year, while 30,000 more need
a replacement valve but can’t receive one because the method
of replacement—open-heart surgery—is too risky for them.
The transcatheter aortic valve replacement procedure gives
these high-risk patients a safer option.
The Heart & Vascular Center was one of only 23 heart
centers (17 in the United States) selected to participate in the
PARTNER trial (Placement of AoRTic traNscathetER valves)
testing this procedure. The PARTNER trial was supported in
part by gifts to The Foundation for Barnes-Jewish Hospital.
Barnes-Jewish was the first and only hospital in the St. Louis
area in 2011 to offer this unique, minimally invasive aortic
valve replacement option, which requires the combined
efforts of cardiac surgeons, interventional cardiologists and
cardiologists. The hospital’s team has been performing this
technique since 2008.
Ralph Damiano Jr., MD, chief of cardiac surgery
at Barnes-Jewish and Washington University School
of Medicine, and John Lasala, MD, PhD, medical
director of the cardiac catheterization laboratory
at Barnes-Jewish, were co-principal investigators of
the trial at the university. Other Washington University
physicians at Barnes-Jewish who conducted the
PARTNER trial were Hersh Maniar, MD, cardiac
surgeon, and Alan Zajarias, MD, an interventional
cardiologist who spent six months in France training
with the procedure’s developer.
“This procedure has the potential to dramatically reduce
the risk of valve replacement, particularly in elderly,
high-risk patients with a much quicker return to full
activity in our patients,” Dr. Damiano says.
Dr. Lasala agrees. “This is a monumental breakthrough
for patients with aortic stenosis who are considered
inoperable,” he says. “The average patient age is
84 but we have done the procedure for patients
up to age 98. If patients were not surgical candidates
previously, we can now do something to help them
live longer and feel better.”