Question: My cardiologist says I have aortic steno- sis and need a new aortic valve. He also mentioned that the FDA has approved a new rocedure that re- laces the aortic valve without open-heart surgery. This option sounds safer to me, but my doctor says this new option is not or everyone. Can you walk me through the pros and cons of these two approaches? Answer: The short answer may seem facetious: Ask your doctors. In fact, it's a compli- cated decision that requires an indi- vidualized answer depending on your health, your prefer- ences and -- above all -- the experience and skill of your cardiac care team. With that said, let's discuss some gen- eral considerations. The aortic valve is a three-flapped structure that en- sures the one-way flow of blood from the heart's main pumping chamber to the rest of the ody. In some peo- ple, the aortic valve ecomes encrusted with calcium de- posits that stiffen and narrow it, re- stricting blood flow. When people with aortic stenosis start feeling symp- toms such as light- headedness or fainting, breath- lessness, fatigue and loss of ap- petite, quality of valve required open-heart surgery. Now that the FDA has approved a no- surgery technique for replacing a failed aortic valve, many people with aortic stenosis are asking, "Can I get this procedure?" The answer is "Maybe." That's because the FDA has currently re- stricted its use to people who are not good candidates for open-heart sur- gery. As you point out, it's easy to see why people might pre- fer the new ap- proach, called transcatheter aortic valve implantation, or TAVI. The new valve is placed using a wire, or catheter, that is ma- neuvered into the heart from a blood vessel in the groin. Both the hospital stay and recovery are shorter and less painful than with open-heart surgery. The FDA based its approval on a clinical trial dubbed PARTNER. In this trial, 69 per- cent of the patients undergoing TAVI were alive after a year, compared with 50 percent of a group that received standard therapy, which included balloon valvulo- plasty, an attempt to increase the valve opening with a balloon-tipped catheter. PARTNER data presented at a sci- entific meeting in late 2011 showed that more than with 43 percent in the TAVI group. Another analysis found that quality- of-life scores after one year among the TA VI group im- proved by 32 points on a 100- point scale, while scores among the standard-care group improved by only 4 points. But although it prolongs life and is less invasive than open-heart surgery, TAVI has its draw- backs. TAVI recipi- ents in the PARTNER trial had more than twice the number of strokes and many more serious bleeding complica- tions than patients in the other group. The bleeding prob- lems were mostly related to the wide catheter that's used during TAVI. vidual basis, taking into account your specific health sta- tus. That's where your heart team can be very useful in advising you. People who are treated with TAVI may live longer than patients who undergo standard therapy, but the procedure does have limitations that need to be con- sidered, too. The FDA stipu- lates that a surgeon must help deter- mine which people with aortic stenosis are eligible for TA VI. Patients may be eligible because they have an un- healthy aorta (the main pipeline for blood from the heart to the body), chest tissue that won't heal well due to past radiation treatment, previ- ous artery-bypass surgery that makes another surgery impractical or sim- ply a very weak heart. The TAVI proce- dure is an prime example of as- tounding medical innovation. But it still takes old-fash- ioned experience and judgment to decide when to use this new technol- ogy. OUR GOOD HEALTH 2 Rubin Dr., Rushville Open Mon.-Sat. Expanded Hours for your convenience: Mon-Thurs 7:30am-7pm; Fri 7:30am-5pm; Sat. 8am-12pm Call 585-554-4400 to schedule an appointment. Currently accepting new Medical and Dental patients. Accepting all insurances, including Medicaid & Medicare. Sliding fee discounts available to qualifying patients with no, or limited, insurance. No-surgery option for aortic stenosis is not for everyone By the faculty of Harvard Medical School Copyright 2012 the President and Fellows of Harvard College. Developed by Harvard Health Publications (www.health.harvard.edu). Distributed by Universal Uclick for UFS. Submi questions to harvard_adviser@hms. harvard.edu. Chronicle-Express.com • The Chronicle-Expr ess • We dnesday , Mar ch 7 , 201 2 B5