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 The procedure can yield "excellent short- and mid-term outcomes in a
patient population with a lethal disease that without this
technology would undoubtedly die,” Dr. Vinod H. Thourani from Emory
University, Atlanta, Georgia told Reuters Health by email.
The results of the study, involving patients in their nineties, were
"surprising and quite honestly rewarding," Thourani added.
Known as transcatheter aortic valve replacement (TAVR), the new
technique has been revolutionizing the care of patients with a
narrowed aortic valve (so-called aortic stenosis) who are too frail
to undergo the traditional "open" surgery.
Instead of cutting through the chest to reach the heart, doctors
insert the new valve through a catheter that's been threaded into
the heart through a small incision in the arm or the groin.
For the current study, Thourani and colleagues looked specifically
at outcomes in some of the oldest patients to participate in a large
randomized trial called PARTNER-I, which was the first multicenter
randomized trial to show the superiority of TAVR over medical
therapy.
In the 531 nonagenarians who underwent TAVR, procedural success
rates were 74 to 78 percent, the researchers reported in Annals of
Thoracic Surgery.
Within the first 30 days after TAVR, roughly a third of the patients
had some kind of major complication - such as a stroke, renal
failure, or need for a pacemaker - and 38 patients (7 percent) died.
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But once patients recovered from the surgery, their risk of death
was equivalent to that of the general population, according to the
researchers.
By six months after TAVR, patients were reporting significantly
better quality of life than they had at baseline, the researchers
found.
These extremely elderly patients would face very high risks from
open surgical valve replacement, but "with the advent of this TAVR
procedure, cardiac surgeons and cardiologists are able to offer
these well-deserving patients a treatment option that otherwise
would have been prohibitive,” Thourani said.
SOURCE: http://bit.ly/1Fg5mtg Annals of Thoracic Surgery, online
August 1, 2015.
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