ASE: Transcatheter AVR offers nonsurgical alternative

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Patients unable to undergo open-heart surgery may be candidates for a new nonsurgical aortic valve (AVR) replacement procedure, according to a study presented Tuesday at the American Society of Echocardiography (ASE) meeting in Washington, D.C.

Transcatheter AVR is a promising new treatment for patients with severe aortic stenosis who are considered high risk for conventional surgical AVR. With this approach, echocardiography is used to guide interventional cardiologists through the procedure and to assess the effects of intervention after the procedure. However, the FDA has not yet approved transcatheter procedures for AVR.

"Some people with severe aortic stenosis, or narrowing of the aortic valve, are not good candidates for open-heart surgery because they may have other medical conditions that would classify them as high risk for surgery," said the study's lead author, Linda D. Gillam, MD, from Columbia University Medical Center in New York City. "This less invasive approach proved to be as effective as surgical aortic valve replacement with the patients in the study and can be done in a cath lab with less stress to the patient and a shorter recovery period."

The researchers included a total of 24 patients with symptomatic aortic stenosis, who underwent successful transcatheter AVR or surgical AVR. There were no significant baseline differences between the two approaches.

The investigators concluded that transcatheter and surgical AVR result in comparable improvements in radial strain, strain rate and left ventricular ejection fraction in elderly patients with severe symptomatic aortic stenosis.

"People in their 80's have a 5 to 10 percent mortality rate when undergoing surgery for aortic valve replacement," Gillam said. "These findings are especially critical for elderly patients who could not survive open-heart surgery."