Valve replacement surgery not what it used to be

WORCESTER, Mass. — The human heart is a complicated, masterfully designed organ on the one hand — but incredibly simple on the other. It is a pump. And like any pump, it’s got parts that can wear out. Case in point: its valves.

In fact, one of the most common cardiac maladies of old age is aortic valve stenosis — which basically could be translated to the hardening of the aortic valve — a part of the heart that pushes blood out to the body.

“So these valves have to open and close every single time the heart beats,” said Nikolaos Kakouros, MD, a cardiologist at UMass Memorial Medical Center in Worcester.

Over time, the valves can wear out, he said.

“(The valve) becomes thickened and stiff, develops calcium bone-like deposits on it that don’t allow it to open well,” said Kakouros.

Aortic stenosis is generally a progressive condition worsened, in part, by the heart’s valiant struggle to keep up with its diminished capacity to pump. Over time, the pressure within the cardiac cavity rises as the valve has to push harder to get blood out to the body. Even maintaining a reasonable blood pressure eventually becomes difficult.

But the heart can only compensate so much — and, left untreated, aortic stenosis can kill patients within a couple of years.

“They either pass out or they have a heart attack or they have sudden death or an arrhythmia because the heart muscle just can’t keep up with that high pressure anymore,” said Jennifer Walker, MD, also a cardiologist at UMass Memorial Medical Center.

Unfortunately, there is no medication that can cure or even ameliorate aortic stenosis. The only treatment is surgery.

“You have to put the patient to sleep, cut their sternum, cut their chest open,” Kakouros said. “Put the body on a heart-lung bypass machine to keep the blood flowing to all the important organs.”

In other words, major surgery that fragile patients might not survive.

But increasingly, cardiologists have been treating aortic stenosis with no cracked ribs and no slice down the torso. In fact, aortic valves can now be replaced through a tiny incision in the groin. The 45-minute procedure is called Transcatheter Aortic Valve Replacement or TAVR.

UMass Memorial invited Boston 25 News to film the procedure on an 80-year-old patient who had such significant aortic disease that a balloon, inserted into his diseased valve to widen it for a replacement, was popped by the sharp, calcium deposits that had accumulated over the years.

During traditional, open-heart surgery for aortic stenosis such deposits are scraped before the new valve is stitched in, said Walker. But with TAVR, those deposits act to secure the implanted valve — meaning one less intervention during an already less-invasive procedure.

TAVR is not for every patient. For example, patients receiving mechanical valve replacements (instead of porcine or bovine valves) must undergo major surgery, said Kakouros.

But for older patients and those otherwise in poor health, TAVR can be a potential lifesaver.

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