New, Less invasive heart surgery, safer alternative for elderly

September 9, 2015

Open heart surgery is a risky procedure, especially for older patients. A new procedure is providing a safer, less invasive alternative to replace heart valves.

The procedure, called the transcatheter aortic valve replacement (TAVR), inserts a new valve through a catheter from either the groin (TF-TAVR) or the ribs (TA-TAVR), leading to the heart. The procedure is designed to help patients who are too weak for surgery.

“Historically, extreme elderly patients can be at a very high risk for open surgery,” said Dr. Vinod H. Thourani, Chief of Cardiothoracic surgery of Emory University Hospital.

“We still believe that for those 90 year olds who are low-or intermediate risk, surgical options may be a viable procedure. However, with the advent of TAVR technology, we can now offer these extreme elderly patients a treatment option that otherwise would have been high-
risk or prohibitive.”

For the study, 531 patients who are 90 years or older had TAVR between 2007 and 2012. Their recovery and quality of life were then monitored for six months.

“Compared with an age-sex-race-matched US population, the TAVR patients had a comparable risk of mortality, and quality of life improved within 6 months of the procedure. Our study shows that age alone should not preclude referral for TAVR in patients age 90 years and older.” explained Dr. Thourani.

The 30-day stroke risk was 3.6% in TF-TAVR patients and 2.0% in TA-TAVR patients. Complications, such as bleeding or vascular issues, occurred in 35% of TF-TAVR patients and 32% of TA-TAVR patients, and more than 80% of patients were discharged home after the procedure.

“Future studies are needed to address potential differences in outcomes between TF- and TA-TAVR groups,” said Dr. Thourani, “but I’m thrilled that we’re able to give elderly people the chance to continue enjoying life in their golden years. Many would not have had that option without TAVR.”

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