Medical advances should be better appreciated
Published: Sunday, October 13, 2013
Updated: Sunday, October 13, 2013 21:10
A new treatment, Tran-Catheter Aortic Valve Replacement (TAVR), has recently been approved for one the most common valvular diseases in America. According to the U.S. Census Department, aortic stenosis is the most common valvular disease with a prevalence rate affecting five of every 10,000 adults, 1.5 million Americans.
Aortic stenosis is a disease in which the opening out of the heart is narrowed due to calcific buildup on the aortic valve. Stenosis of the aortic valve is most commonly caused by age-related progressive buildup of calcium. As a result, most patients diagnosed with the disease are in their late 60s.
As aortic stenosis impedes blood flow from the heart, if left untreated it may cause congestive heart failure, a fatal complication.
With this disease affecting the health of a larger number of patients, the prevalence rate of aortic stenosis is expected to increase as the U.S. population ages. Currently, the most effective treatment for severe aortic stenosis is open-heart surgery in which cardio-thoracic surgeons medically stop cardiac activity, dissect the aorta, excise the diseased heart and insert a new valve.
However, since many patients diagnosed with aortic valve stenosis are over 60 years old, they are often denied open-heart surgery due to the risks they could face.
As a result, the only other option for treatment before the approval of TAVR was medical treatment in which the two-year mortality rate for medical treatment was 50 percent, according to a study published by the New England Journal of Medicine.
Thus, a newer and safer intervention was needed. On Nov. 2, 2011, the U.S. Food and Drug Administration approved TAVR. This approval gave hope to patients who were deemed too weak to withstand normal open-heart surgery.
Contrary to open-heart surgery in which there is a temporary cessation of cardiac activity, TAVR is preformed while the heart is still pumping.
This non-surgical procedure begins with a team of cardiologists, cardiothoracic surgeons and perfusionists, who create a small two to three centimeters incision on the groin area and thread a catheter, a long, flexible tube, via the femoral artery to the heart. The new aortic valve is crimpled up and fitted inside the catheter over a deflated balloon. Once doctors have positioned the catheter at the aorta, the team deploys the new valve over the old valve through a balloon angioplasty. As the balloon inflates, the new valve expands over the diseased valve.
Because the non-surgical intervention utilizes minimal invasive techniques, these high-risk patients often recover quickly with almost immediate improvement.
Although recently approved by the FDA, hundreds of TAVRs have been performed, saving lives of the most vulnerable.
Hartford Hospital performed its first TAVR on Feb. 8, 2012. In addition, research is beginning to be published on the efficacy of the TAVRs. Although many see this treatment is better than conventional open-heart surgery, the reality is that TAVR might be not as effective as surgical intervention
UConn researchers are also taking part in this new paradigm, as biomedical engineers are testing the strenuous conditions of the valves.
UConn’s Tissue Mechanic Lab, supervised by Dr. Wei Sun, is currently one of the few labs working on improving the efficiency of the valve to overall improve the treatment of cardiovascular disease.
Appreciation of medical wonders such as TAVR is uncommon. Often the subtle perfections of medicine aren’t appreciated until one is in dire need of a miracle. Medicine is not only is a science, but an art. Like any art piece, society ought to appreciate its beauty.