Berks County Medical Society Medical Record Fall 2019 - 10

m E d i C a l r E C o r d F E at u r E

Interventional Tactics in the
Treatment of Severe Aortic Stenosis:
Major Contribution or Major
Controversy?
by Spencer Barbera
BCMS Pat Sharma President's Scholarship recipient
BCMS Mentor: Andy R. Waxler, MD, FACC, Penn State Health Berks Cardiology

E

very year in May Tulane University students in New Orleans
are abuzz, not because of the exams they are about to take
but because of the most anticipated music event of the year:
Jazz Fest. The iconic music festival brings in thousands of tourists
and some of the most highly-regarded music groups from across the
globe. This year, the Rolling Stones were set to headline the music
festival, with their lead singer, Mick Jagger. Several of my friends
purchased their tickets months in advance for the opportunity to
see the legends of rock and roll live in the Big Easy. You can imagine
their immeasurable disappointment when they received word that
the Rolling Stones had to back out of the gig. Initially, details as to
why the band could not perform were sparse. The only information
provided to the public was in the form of a press release that stated
Mick Jagger was ill and needed to undergo medical treatment
(Rolling Stones, 2019). As time went on, rumors laced with
kernels of truth surfaced claiming that 75-year-old Mick Jagger was
undergoing "heart surgery" (Brito, 2019).
A little over a week after the procedure took place, the superstar
tweeted a picture of himself up and walking in Central Park, New
York City (Jagger, 2019). This rapid recovery suggests it was not
quite heart surgery in the traditional sense; but rather a relatively
new procedure that has been rapidly evolving in the field of
structural cardiology for almost a decade (Pick, 2019). There are few
innovations in medicine that have changed healthcare as rapidly or as
profoundly as transcatheter aortic-valve replacement (TAVR).

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TAVR
The aortic valve is a cylindrical opening at the top of the heart,
and all blood pumped by the heart must travel through this opening
to be disseminated throughout the rest of the body. When this
opening is blocked, even partially, there is an extreme adverse impact
on a patient's immediate and long-term health, a condition dubbed
"aortic stenosis." Aortic stenosis is most commonly caused by
calcium buildup in the aortic valve, or, less commonly, a congenital
defect in the formation of the trileaflet valve, thus giving the patient
a hemodynamically-disadvantaged bileaflet valve (Newheartvalve.
com, n.d.). Aortic stenosis afflicts almost 1.5 million people in the
United States annually, and of those 500,000 are labeled as having
severe aortic stenosis ("U.S. Aortic Stenosis Disease Prevalence &
Treatment Statistics," n.d.). The "severe" description often suggests
that the condition has progressed to the point where blood flow
is so restricted that the patient experiences symptoms such as
breathlessness, chest pain, fainting, murmurs, palpitations, and a
reduced ability to accomplish normal activities (American Heart
Association, 2016).
Only ten years ago, patients with severe aortic stenosis had
just two treatment options. The first: undergo a surgical aorticvalve replacement (SAVR), an operation in which the heart valve
is replaced through open-chest surgery followed by a 5-to-10-day
hospital recovery time and, generally, one to three months of
discomfort following the operation ("Recovery from the procedure,"
n.d.) . The second option: receive no treatment and let the aortic


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Berks County Medical Society Medical Record Fall 2019

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