Hi Anonymous,
We heard back from our cardiac specialist associated to the website. Here is his reply:
"The standard treatment of severe symptomatic aortic stenosis is surgical aortic valve replacement. The diseased, narrowed valve is removed and a new valve is inserted, relieving the heart of the extra work and the patient of their symptoms. It is very effective. The risk of the surgery depends on a variety of factors (heart function, other organ function, etc.). Age is a risk factor but there is no absolute cutoff. If the patient is otherwise healthy aortic valve replacement surgery can be performed in patients in their 90’s or even over 100 with relatively low risk (5-10%). The key is determine that the patient will have a good quality of life after surgery.
In some patients the risk of open surgical valve replacement is considered to high (e.g. >30%). This may be because the patient is elderly and frail or because of additional risk factors (poor heart function, lungs, kidneys, etc.). Until recently there were no good options for these high risk patients. The procedure you mentioned, balloon aortic valvuloplasty (BAV), is not commonly used. This non- surgical procedure involves threading a balloon catheter through an artery in the [groin] and stretching open the blocked valve. The treatment can decrease the blockage but sometimes at the expense of creating leakage. More importantly, the treatment does not last. In most patients the narrowing can re-occur fairly quickly, in as little as a few months. Because of this, the procedure is used in rare situations as a temporizing procedure. Sometimes a patient may be too acutely ill to tolerate surgery. The balloon procedure is performed to open the valve until the patient improves to the point where traditional valve replacement can be performed.
Finally, a new exciting procedure is currently under development. It is called Transcatheter aortic intervention (TAVI). Like BAV it is a non-surgical procedure performed with a catheter. The blocked valve is stretched open and a new valve attached to a metal frame is deployed. The device is not currently FDA approved in the US (although it is in Europe) and is only available as part of a clinical protocol. The recent data on one of the devices (Edwards Life Sciences – Sapien valve) was encouraging and it is expected to receive approval in late 2011 or early 2012. The other device (Medtronic’s – CoreValve) is a couple of years behind.
If your mom is in relatively good shape despite her age and had a fairly active, good quality life before the valve problem occurred I would encourage her to at least see a heart valve surgeon experienced in very eldery patients (heart-valve-surgeons.com is a good starting point or if you want to pass on your location I can make some suggestions). If she is not a candidate or simply does not want to consider open surgery, then it would be worth considering a TAVI procedure within one of the clinical trials. There are several dozen centers around the country participating in the trial.
Hope that helps,
Dr. Aklog"
Let us know what you find out, and how your mother is doing.
Comment Reply
Hi Anonymous,
We heard back from our cardiac specialist associated to the website. Here is his reply:
"The standard treatment of severe symptomatic aortic stenosis is surgical aortic valve replacement. The diseased, narrowed valve is removed and a new valve is inserted, relieving the heart of the extra work and the patient of their symptoms. It is very effective. The risk of the surgery depends on a variety of factors (heart function, other organ function, etc.). Age is a risk factor but there is no absolute cutoff. If the patient is otherwise healthy aortic valve replacement surgery can be performed in patients in their 90’s or even over 100 with relatively low risk (5-10%). The key is determine that the patient will have a good quality of life after surgery.
In some patients the risk of open surgical valve replacement is considered to high (e.g. >30%). This may be because the patient is elderly and frail or because of additional risk factors (poor heart function, lungs, kidneys, etc.). Until recently there were no good options for these high risk patients. The procedure you mentioned, balloon aortic valvuloplasty (BAV), is not commonly used. This non- surgical procedure involves threading a balloon catheter through an artery in the [groin] and stretching open the blocked valve. The treatment can decrease the blockage but sometimes at the expense of creating leakage. More importantly, the treatment does not last. In most patients the narrowing can re-occur fairly quickly, in as little as a few months. Because of this, the procedure is used in rare situations as a temporizing procedure. Sometimes a patient may be too acutely ill to tolerate surgery. The balloon procedure is performed to open the valve until the patient improves to the point where traditional valve replacement can be performed.
Finally, a new exciting procedure is currently under development. It is called Transcatheter aortic intervention (TAVI). Like BAV it is a non-surgical procedure performed with a catheter. The blocked valve is stretched open and a new valve attached to a metal frame is deployed. The device is not currently FDA approved in the US (although it is in Europe) and is only available as part of a clinical protocol. The recent data on one of the devices (Edwards Life Sciences – Sapien valve) was encouraging and it is expected to receive approval in late 2011 or early 2012. The other device (Medtronic’s – CoreValve) is a couple of years behind.
If your mom is in relatively good shape despite her age and had a fairly active, good quality life before the valve problem occurred I would encourage her to at least see a heart valve surgeon experienced in very eldery patients (heart-valve-surgeons.com is a good starting point or if you want to pass on your location I can make some suggestions). If she is not a candidate or simply does not want to consider open surgery, then it would be worth considering a TAVI procedure within one of the clinical trials. There are several dozen centers around the country participating in the trial.
Hope that helps,
May 18, 2011 - 8:47amDr. Aklog"
Let us know what you find out, and how your mother is doing.
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