Berks County Medical Society Medical Record Fall 2019 - 12

Interventional Tactics in the Treatment of Severe Aortic Stenosis:
Major Contribution or Major Controversy?
continued from page 11

https://www.mayoclinic.org/testsprocedures/transcatheter-aortic-valvereplacement/about/pac-20384698
https://www.mayoclinic.org/diseasesconditions/aortic-stenosis/symptomscauses/syc-20353139

https://www.heart-valve-surgery.com/
aortic-stenosis-valve-heart-narrowing.
php

BENEFITS

CHALLENGES

To elaborate on the previously mentioned benefits to TAVR,
it is clear why the procedure is gaining so much traction so rapidly
among patients and providers alike. In terms of overall cost to the
healthcare system, TAVR's impact is immensely beneficial. The
faster recovery time greatly decreases the need for patients to recover
within the confines of a hospital room. As previously patients would
need to spend over five days under hospital supervision, now they
are only spending two, freeing up hospital physical, human, and
financial resources to reallocate to other more cost-effective areas.
However, patients are the main beneficiaries of this shortened
recovery window, as they are returning to their normal daily
activities faster.

Currently there are several types of synthetic valves used
in TAVR ranging from the SAPIEN 3 transcatheter heart valve
manufactured by Edwards Lifesciences, to Medtronic's Evoult PRO.
The topic of much debate within the medical device community
is exactly how long these valves can last in a human system. Since
TAVR is a relatively new procedure, with the oldest valve being
implanted in a human only about 14 years ago, the longevity of
implanted valves is still largely unclear (Cribier, 2016). The topic
is becoming more and more clinically significant as TAVR is being
conducted on younger, lower-risk patients afflicted with severe
aortic stenosis. These new valve recipients will potentially be living
for longer periods of time with their synthetic valves in place.
Researchers at the University of Michigan and other universities have
started conducting what they deem "valve-in-valve" replacement
procedures for restoring valves that are at risk of breaking or being
rendered ineffective due to the use the device has endured ("Valvein-Valve TAVR," n.d.). In these interventional procedures, a new
valve replacement is implanted inside an old valve replacement.

Additionally, the minimally invasive nature of the interventional
procedure is appealing to patients due to the size and location of the
surgical incision. The incision, less than two centimeters in length,
is made on the upper thigh to access the femoral artery. In contrast,
a SAVR incision is longer, and is made in a much more visible area,
down the center of the chest. Besides the superior cosmetic outcome,
the smaller size of the incision decreases the potential for the area to
succumb to infection, and facilitates faster healing of the wound. It
also significantly decreases the post-operative discomfort, as "open
heart" surgery patients universally report that the sternal pain is the
worse pain of the recovery.

www.berkscms.org

From a research methodology standpoint, the PARTNER 3 trial
still has some innate limitations that prevent it from being the sole
study upon which we build the foundation for all clinical treatment
in the United States. Primarily, the chief limitation is that the study
only provides results at one year following the procedure (Mack MJ
et al, 2019). This lack of long-term data is concerning, and some say
insufficient, to make it the new standard of care. Given the rapid

https://www.mayoclinic.org/tests-procedures/transcatheter-aortic-valve-replacement/about/pac-20384698 https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/symptoms-causes/syc-20353139 https://www.heart-valve-surgery.com/aortic-stenosis-valve-heart-narrowing.php http://www.berkscms.org

Berks County Medical Society Medical Record Fall 2019

Table of Contents for the Digital Edition of Berks County Medical Society Medical Record Fall 2019