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Minimally Invasive Surgery Provides Option for High-Risk Aortic Stenosis Patients

Patients with aortic stenosis who are considered high risk for traditional valve replacement surgery, now have another less invasive option. Transcatheter aortic valve replacement (TAVR) is providing an alternative for patients considered too frail for traditional open heart surgery.

Greg Pavlides, MD
Greg Pavlides, MD

"This usually involves patients who are in their 80s or 90s," says Greg Pavlides, MD, interventional cardiologist at Nebraska Medicine. "Before we started offering this procedure, as many as 40 percent of people in this age group would be denied surgical treatment. Without surgery, most will survive another one to three years with a more conservative approach like medications."

Aortic stenosis is the most common valve disorder we see and as the population ages, we are going to be seeing more of this disease, says Dr. Pavlides.

A randomized clinical trial called the PARTNER trial reported in the New England Journal of Medicine revealed that the results provided by TAVR in high-risk patients with aortic stenosis were equal to that of open heart surgery. In comparison, in patients in which nothing was done or a conservative approach was taken, 50 percent died within a year.

Another study (the first United States Registry) on inoperable or very high-risk patients reported in a 2013 issue of JAMA, showed equally impressive results, notes Dr. Pavlides. Of the 7,700 patients treated, there was a 5 percent hospital mortality rate.

Currently, TAVR is only approved for patients who are either at high risk for conventional open heart surgery and aortic valve replacement or inoperable. "There is no available data yet on low-risk patients, but we expect more patients will be treated with TAVR in the future as studies become available that confirm its effectiveness on this group as well," notes Pavlides.

Mike Moulton, MD
Mike Moulton, MD

Dr. Pavlides and Michael Moulton, MD, cardiothoracic surgeon at Nebraska Medicine, both have received special training to perform the procedure.

Dr. Pavlides began performing the procedure in 2007 in Europe, at the Onassis Cardiac Surgery Center in Athens, Greece, where he was the chief of interventional cardiology. He has since performed more than 150 procedures.

The procedure is performed in a catheterization lab or hybrid catheterization lab by a team of physicians that includes cardiac surgeons, interventional radiologists, anesthesiologists and imaging technicians.

The TAVR procedure involves making a small incision in the groin or in the chest. Using X-rays and echo guidance, a fully-collapsible replacement valve is then threaded to the valve site through a catheter. Once the new valve is expanded, it pushes the old valve leaflets out of the way and the tissue in the replacement valve takes over the job of regulating blood flow.

"There really is nothing else like it," says Dr. Moulton. "Patients recover well, they don't have pain in their chest and typically can be in and out of the hospital in two to four days."

To learn more, make a referral or connect with Dr. Pavlides or a member of the Heart Center team call, 402-559-8888 or visit us online at NebraskaMed.com/Heart/About.