A ‘rock star’ treatment for your heart

Recent high-profile “rock star” media coverage has piqued public interest in a minimally invasive cardiac procedure, known as transcatheter aortic valve replacement (TAVR) – referred to as transcatheter aortic valve implantation (TAVI) in Europe and Asia – used to treat aortic stenosis, one of the most common heart valve diseases. 

As both a practicing physician and the Chief Medical Officer for Image Guided Therapy (IGT) at Philips, I have observed first-hand the rapid evolution of minimally invasive procedures. Our field has made a real difference to patient care. So, it’s hardly surprising that public awareness of our amazing non-surgical procedures is now increasing.  

Another minimally invasive procedure hits the headlines

We are becoming accustomed to seeing headlines on how a minimally invasive procedure is “breaking news” on the world stage. Last year, we learned of the non-surgical procedure performed by interventional radiologists to embolize a kidney tumor in the US’ First Lady.  

And recently another image-guided therapy procedure, TAVR, became the number one news story in the world, leading many of my non-medical friends and family to contact me to understand what exactly happened. 

Aortic stenosis happens when the heart’s aortic valve narrows, preventing the valve from fully opening. This reduces or blocks blood flow from the heart into the main aorta, and on to the rest of the body. When this happens, the heart must work harder to pump blood around the body. This can lead to symptoms such as lightheadedness, shortness of breath or chest pain. Ultimately, if left untreated, it can be fatal.

Evolving treatment: from open-heart surgery to minimally invasive

Aortic stenosis has traditionally been treated via open-heart surgery and aortic valve replacement, a major operation that involves the surgeon opening the chest to access the heart. The procedure can take up to six hours and typically requires a hospital stay of a week or more, with a prolonged recovery time.

First performed on a 57-year-old inoperable patient in 2002, during TAVR the interventional physician inserts the replacement heart valve, threading it most often through a tiny site in the patient’s upper thigh. Using advanced x-ray and ultrasound imaging, which is why we call this “image-guided,” the valve is precisely guided to the heart and deployed at the site of the old failing valve. TAVR can be carried out in as little as 90 minutes and most commonly only requires mild sedation, typically avoiding the need for general anesthesia and intubation.

TAVR had been typically performed in patients who were so elderly or unwell that they faced the risk of not surviving open heart surgery. However, recent findings from two clinical trials showed that TAVR was just as useful in younger, healthier patients and may even be more effective. 

TAVR: an option for more patients

Presented at the American College of Cardiology (ACC) Meetings earlier this year, both the PARTNER 3 Trial and the CoreValve Low-Risk Trial were conducted on patients who were deemed low-risk surgical candidates, not the usual profile of a patient undergoing TAVR. 

Both trials showed notable benefits of the minimally invasive TAVR compared to open heart surgery, including reduced risks of stroke, death and repeat hospital admissions. 

Shorter waiting times and improving access to care

It’s not just the patient who benefits – lengthy hospital stays as seen with open-heart surgery can be dramatically reduced, alleviating pressure on hospital resources. It’s likely that wider use of TAVR will result in a corresponding decrease in waiting times for treatments. 

The result? Increased satisfaction all round. 

A growing and aging population means that incidence of heart valve disease is only likely to increase. And what goes hand in hand with this are longer waiting times, already in evidence across the globe. On a recent trip to Thailand I learned that the average waiting time for similar procedures is one year. So, it’s more important than ever to have efficient solutions that can contribute to reduced costs, shorter hospital stays, and improve efficiency and workflow. I believe that TAVR’s adoption will increase worldwide, in no small part because of the leading innovations from Philips in advanced x-ray interventional suites and navigation tools, which help make TAVR more precise and efficient. 

I’m thrilled to see “rock-star” publicity bring awareness to image-guided therapy innovations like TAVR, which will help get more people back to living the lives they love and doing the things they enjoy.

Nearly two thirds of patients with severe aortic stenosis do not receive the appropriate treatment, according to one study.  But the recent trial data is really encouraging news. Physicians and patients are now optimistic that the FDA is anticipated to approve the procedure for lower-risk patients later this year.

What would you do with a new lease on life?

This blog post was originally published on the Philips News Center.