New heart valves could let more people avoid surgery

Surgery for some defective heart valves may soon become a thing of the past. New studies suggest that it is correct and often better to place a new valve through a tube in an artery.

The results should quickly transform the treatment of a problem that affects millions of people – a rigid or narrowed aortic valve that does not let blood flow as it should. Until recently, the repair of severe cases required a major operation using a heart-lung machine while the surgeons cut out the old valve and sewed a new one.

Ten years ago, expandable aortic valves were developed. They can be guided to the heart through a catheter into a blood vessel and placed inside the old valve. But they are only used now in people at high or moderate risk of dying from surgery. New studies have tested these valves in people at low risk of surgery, as are most patients, and found them good or better than surgical ones.

"It's our last frontier" to make these devices a standard of care, said Dr. Joseph Cleveland, a cardiac surgeon at the University of Colorado with no role in studies or any connection to companies that have sponsored them. "It's a good thing" for patients to be able to avoid major surgery, he said.

The findings were published Saturday by the New England Journal of Medicine and were to be discussed at a conference of the American College of Cardiology in New Orleans on Sunday.

In one study, approximately 1,000 patients underwent standard surgery or Edwards Lifesciences Expandable Valve. At the end of one year, 15% of the surgical group and 8.5% of the others had died, had a stroke or had to be hospitalized again.

In the other study, 1,400 patients underwent surgery or a Medtronic expandable valve. On the basis of partial results, the researchers estimated that after two years, 6.7% of the surgical group and 5.3% of the others had died or had a disabling stroke.

In both studies, some problems were more common during surgery, including significant bleeding and the development of a floating heart rhythm called atrial fibrillation. In the Medtronic study, 17% of expansile valve recipients then needed a pacemaker, compared to 6% of operated patients.

Previous research suggests that the overall cost of expandable valves is less than $ 30,000 versus $ 5,000 for surgical procedures, largely because they require a much shorter hospital stay and fewer complications, said Cleveland from the College of Cardiology.

Posted in Daily Times, March 18^th 2019.