Heart surgery may be getting less invasive with a new endoscopic procedure that can replace the aortic valve. This exciting development is happening thanks to two successful procedures done on humans in France. The procedure is described in the Journal of Thoracic and Cardiovascular Surgery.
The aortic valve is on the left side of the heart and it opens to allow blood to flow from the left ventricle into the body. The valve closes to prevent the blood from flowing back in. The left side of the heart pumps blood to send throughout the entire body, while the right side of the heart pumps blood to the lungs. The left side of the heart must work harder than the right.
The patients in endoscopic aortic valve replacement (TEAVR) were 82 and 93 years old, respectively. Both patients were diagnosed with aortic valve stenosis. Aortic valve stenosis keeps the aortic valve from fully opening to allow blood out of the ventricle because the valve is narrowed. This will affect the whole heart, as it will cause the heart to work harder to empty the blood and distribute it throughout the body. There are no medications that can help with stenosis reversal, the valve must be repaired. The three main causes of aortic valve stenosis are congenital heart defect, a buildup of calcium on the valve that can come with age, and rheumatic fever which can cause scar tissue to develop on the valve.
Transcatheter aortic valve replacement (TAVR) has been available since 2012, but under very specific conditions. TAVR is limited to patients that have been determined to be unsuitable, or very at very high risk, for surgery. TEAVR might make endoscopic aortic valve replacement a possibility for many people, which means heart surgery might have just become a lot less invasive. The two patients who underwent this procedure were released to go home about a week after the procedure was performed. They have not reported any complications since discharge.
While undergoing TEAVR, the patient’s heart must still be bypassed. There are many benefits to this new procedure, including that open heart surgery is still a possibility. If it is determined during TEAVR that the patient needs open heart surgery, that switch can easily be made. The other benefits to this procedure include no sutures, and a quicker recovery.
Each patient was under coronary bypass for around two and a half hours, though actually putting in the device for the aortic valve was around 45 minutes. It is believed that as technology improves, this procedure will become even easier and quicker. Marco Vola, MD, PhD, is the lead author of the published paper describing the procedures, and is also from the Department of Cardiovascular Surgery at Centre Hospitalier Universitaire de Saint-Etienne in France. Dr. Vola said that the success of these two procedures prove that TEAVR is feasible. He also noted that, “Further clinical experience and technical development are necessary to shorten operation times and to assess further the potential post-operative benefits of TEAVR.”
As technology develops and more clinical experience is gained, this new procedure may become more common. As endoscopic aortic valve replacement becomes more common, heart surgery will continue to get less invasive.
By Ashley Campbell