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Barnes-Jewish Hospital

Breakthrough Heart Procedure Offers Second Chance for High-risk Patients

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 Once in position, a stent-like valve is inflated in the aorta and the balloon and catheter are withdrawn.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.”

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