|Emory University Hospital is one of five hospitals nationwide, and the first hospital in the Southeast, to study a non-surgical treatment option for severe aortic heart valve disease, commonly called aortic stenosis.
Emory University interventional cardiologists are performing percutaneous aortic valve replacement as part of a clinical trial comparing this procedure with traditional, open-heart surgery or medical therapy in high-risk patients with aortic stenosis.
Percutaneous aortic valve replacement provides a new tool for doctors to treat patients who currently cannot be treated with traditional surgical techniques. In addition, an effective medicine for this condition has not been found. In this new procedure, doctors create a small incision in the groin or chest wall and then feed a wire mesh valve through a catheter and place it where the new valve is needed.
"The results we've seen so far in this clinical trial show great promise for this procedure," says interventional cardiologist Vasilis Babaliaros, MD, assistant professor of medicine at Emory University School of Medicine.
"Our goal is to find an alternative to open-heart surgery for patients who would benefit from a less invasive procedure," says Dr. Babaliaros. "This procedure is much easier on the patient and it offers a quicker recovery time. Importantly, it may also extend the lives of many people who are too ill or too frail to endure open-heart surgery."
Aortic valve stenosis is a condition that often occurs with age, leading to calcification or narrowing of the valve. It is most common among elderly patients over 70 years of age, but can surface earlier in life in those with rheumatic heart disease or congenital abnormalities of the valve.
Severe narrowing of the aortic valve restricts normal blood flow to the entire body, and patients often develop symptoms of chest pain, shortness of breath, fainting spells and heart failure.
Once symptoms develop, the standard therapy is to remove the diseased valve through open-heart surgery. This surgical procedure has been used to treat aortic stenosis for more than 30 years. However, doctors are concerned that in patients with advanced age, end-stage disease or other serious health concerns, an open chest procedure has greater risk for problems or possibly death
"This disease is becoming increasingly well understood and we believe we are taking a giant step forward," says Peter Block, MD, FACC, professor of medicine, Emory School of Medicine. "This is especially important since tens of thousands of Americans are diagnosed with failing valves each year and that number is expected to increase substantially in the coming years as baby boomers pass the age of 70."
In 2002, the first percutaneous heart valve replacement was successfully implanted by French cardiologist Alain Cribier, MD, in a seriously ill patient with aortic stenosis who had been refused for surgery.
Over the past few years, Emory's Dr. Babaliaros has worked along side Dr. Cribier in order to learn the new approach and bring his expertise to the U.S. and to Emory.
Drs. Babaliaros and Block are leading the Emory clinical trial, along with cardiac surgical colleagues, Drs. Robert Guyton, Vinod Thourani and Thomas Vassiliades. They have performed the percutaneous aortic valve replacement in two patients at Emory University Hospital since the study began in late September. Both patients returned home within three days of the procedure.
During the innovative procedure, the doctors use a cath e ter to carry a new aortic valve made of animal tissue sewn to the interior of a large stent, which is a cylindrical mesh of stainless steel. To deliver the device, they attach it to the tip of a plastic catheter and compress it to the width of a pencil.
The catheter is introduced through a small incision in the thigh or rib area and is threaded toward the heart through the large blood vessel called the aorta. Pictures of the heart and aortic valve are obtained through three-dimensional echocardiography (ultrasound) or x-ray and the images are transmitted to aid the cardiologists as they perform the procedure.
Once the catheter is properly positioned in the opening of the aortic valve, the new valve is rapidly expanded. As it expands, the new valve pushes the diseased, native valve aside, allowing blood to flow normally through the implanted valve to the rest of the body.
Emory Heart & Vascular Center doctors are committed to providing clinically excellent cardiovascular patient care, pioneering innovative clinical research and training the best heart specialists in the world. The Center is consistently recognized by U.S. News & World Report as one of the top heart centers in the country.
Emory is currently screening patients to participate in the phase II clinical trial. For more information, please contact the Andreas Gruentzig Cardiovascular Center of Emory University at 404-712-7667.