Improved Treatment for a Common Heart Valve Problem

A newly approved treatment for severe aortic stenosis offers hope to elderly patients. The treatment implants an artificial valve in the heart through a catheter, which is much less invasive than open heart surgery. Let’s look at why this is helpful.

Dangers of Aortic Stenosis

Aortic stenosis is a condition that narrows the opening through which the heart’s left chamber, or ventricle, pumps blood. This valve is where blood flows into the aorta, the artery that carries blood to the heart and the rest of the body. Aortic stenosis is the most common valve abnormality in the U.S., affecting about 25 percent of people over the age of 65. Fortunately, the narrowing produces no symptoms in most. More severe narrowing, however, forces the left ventricle to work harder, which can cause heart failure. It also limits the amount of blood entering the aorta, resulting in chest pain (angina) and fainting episodes (syncope).

Treatment of Life-Threatening Aortic Stenosis

After development of heart failure, angina, or syncope due to aortic stenosis, the average life expectancy is only 2 to 3 years. Up to now the only cure was surgical replacement of the abnormal valve. However, many patients are too sick or weak to undergo open heart surgery to replace the narrowed aortic valve.

But another option became available in late 2011 when the Food and Drug Administration approved implantation of an amazing new device—an artificial aortic valve that can be threaded into the heart through a catheter

Results of Two-Year Clinical Trial  

An article in a May 2012 issue of the New England Journal of Medicine reported on a clinical trial  that included 699 patients (average age 84 years) with severe aortic stenosis. Patients were randomly assigned to two groups:

• open heart valve replacement, or
• insertion of an artificial valve.

After two years, improvements in symptoms were the same.  And there were no significant differences in date rates. Mortality from any cause or deaths from cardiovascular disease  was about the same  with the two types of treatment. In the second year, however, there was a problem with more leakage of blood around the implanted artificial valve, and this was associated with increased deaths.

Hope for Those Who Cannot Undergo Open Heart Surgery

Although the high risks in these elderly patients is evident from the deaths (from all causes) of about 34 percent in both groups of  patients, the newly approved procedure at least offers some hope for those who are unable to withstand open heart surgery. And further improvements in the artificial valve or the implantation procedure may improve the outcomes even further.