Minimally-invasive failed biological aortic valve replacement successful in high risk patients

May 6, 2013

When a biologic aortic valve prosthesis fails, the patient often faces a high risk valve replacement through repeat open heart surgery. A new technique, known as Valve-in-Valve, uses minimally invasive techniques to introduce a collapsible aortic heart valve into the damaged valve in order to restore function. This procedure avoids the need to open the chest or use cardiopulmonary bypass (heart-lung machine), according to Leo Ihlberg, MD, PhD, a cardiothoracic surgeon at the Heart and Lung Center of Helsinki University Hospital, Finland, who will be presenting the results of a new study at the 93rd AATS Annual Meeting in Minneapolis on May 6, 2013.

For decades, replacing faulty with a biological valve prosthesis has been a standard procedure in modern heart surgery. However, these valve substitutes have a limited as they degenerate over time, prompting a need to replace them. Traditionally done in a repeat open heart operation using cardiopulmonary bypass, these procedures have far more risks involved and are often more difficult on the patient than the .

Transcatheter Aortic Heart Valve (TAVI) is a procedure involving a collapsible aortic heart valve that can be manipulated into place with minimally-. The surgeon introduces the collapsed valve through a tube inserted into the groin or between the ribs and guides it through the blood vessels and into the failing valve. The damaged valve is sealed off and the collapsed valve is then inflated to restore function. This can be done while the heart is still beating (without using cardiopulmonary bypass) and without opening the chest.

"There has been a trend towards lower age at which a bioprosthesis is preferentially chosen over a substitute. Biologic valves, however, have limited durability due to late degenerative valve failures and dense calcification that often necessitates reoperation," says Dr. Ihlberg, a at the Heart and Lung Center of Helsinki University Hospital in Finland.

By the time a valve fails, oftentimes patients are elderly and experiencing deteriorating health. Thus, there is an increased need for an alternative to replacing a damaged such that it avoids mortality (estimated at 2-30%), morbidity, longer hospital stay, and prolonged recovery associated with repeat . The Valve-in-Valve technique could be that option for these patients.

In this report of 45 Valve-in-Valve surgeries performed in elderly patients in four Nordic countries (Finland, Sweden, Norway, and Denmark) with very high or prohibitive risk for a repeat open heart surgery, "the results were excellent in terms of low procedural complications and a significant improvement in patients' functional status," said Dr. Ihlberg. Relief from valve stenosis was incomplete for a small subgroup of patients, although it is unknown whether this will cause any long term side effects. The patients were followed for an average of 14 months, and Dr. Ihlberg will present details regarding short-term and long-term cumulative survival rates, causes of death, and functional and hemodynamic status.

This technique gives patients with failing biologic valves a new, less-invasive option for replacement, especially high risk individuals who cannot undergo a repeat open heart procedure.

At the current time, Valve-in-Valve aortic is done infrequently, but Dr. Ihlberg expects that its use will increase as more surgeons gain experience and more patients require biologic valve replacements after having an initial replacement at an earlier age. Dr. Ihlberg even suggests that initial valve replacements should be done in ways that set the stage for future Valve-in-Valve repairs.

Explore further: Approval expanded for sapien artificial heart valve

More information: "Early Clinical Outcome of Transcatheter Valve-in Valve Implantation in the Nordic Countries," by Leo Ihlberg, Henrik Nissen, Niels-Henrik Nielsen, Andreas Ruck, Rolf Busund, Kaj-Erik Klaarborg, Lars Soendergaard, Jan Harnek, Heikki Miettinen, Markku Eskola, Alexander Wahba, and Mika Laine. Presentation at the 93rd AATS Annual Meeting. May 4-8, 2013. Minneapolis, MN, during the Plenary Scientific Session on May 6, 11:00 AM CT. aats.org/annualmeeting/

Related Stories

Approval expanded for sapien artificial heart valve

October 22, 2012
(HealthDay)—U.S. Food and Drug Administration approval for the Sapien Transcatheter Heart Valve has been expanded to include additional people with aortic valve stenosis, the medical term for a narrowing of the aortic valve ...

UofL physicians, Jewish Hospital first in Kentucky to offer new aortic valve replacement

January 3, 2012
Some individuals with severe aortic stenosis – also known as narrowing of the aortic valve in the heart – who are not well enough to undergo open heart surgery have a new treatment option thanks to a new procedure ...

MDCT helps better determine valve implant size for transcatheter aortic valve in patients with aortic stenosis

April 13, 2013
MDCT is a better way to measure annular size in patients with aortic stenosis who are candidates for transcatheter aortic valve implantation (TAVI) than two dimensional echocardiography, a new study indicates.

Recommended for you

Five vascular diseases linked to one common genetic variant

July 27, 2017
Genome-wide association studies have implicated a common genetic variant in chromosome 6p24 in coronary artery disease, as well as four other vascular diseases: migraine headache, cervical artery dissection, fibromuscular ...

Could aggressive blood pressure treatments lead to kidney damage?

July 18, 2017
Aggressive combination treatments for high blood pressure that are intended to protect the kidneys may actually be damaging the organs, new research from the University of Virginia School of Medicine suggests.

Quantifying effectiveness of treatment for irregular heartbeat

July 17, 2017
In a small proof-of-concept study, researchers at Johns Hopkins report a complex mathematical method to measure electrical communications within the heart can successfully predict the effectiveness of catheter ablation, the ...

Concerns over side effects of statins stopping stroke survivors taking medication

July 17, 2017
Negative media coverage of the side effects associated with taking statins, and patients' own experiences of taking the drugs, are among the reasons cited by stroke survivors and their carers for stopping taking potentially ...

Study discovers anticoagulant drugs are being prescribed against safety advice

July 17, 2017
A study by researchers at the University of Birmingham has shown that GPs are prescribing anticoagulants to patients with an irregular heartbeat against official safety advice.

Protein may protect against heart attack

July 14, 2017
DDK3 could be used as a new therapy to stop the build-up of fatty material inside the arteries

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.