Aortic Valve Replacement - Ali Gheissari, MD
Aortic valve replacement is the mainstay of treatment for aortic stenosis, however it entails risk for some patients with other health problems. We went to Good Samaritan Hospital in Los Angeles and spoke with Dr. Ali Gheissari. We asked him to tell us more about aortic stenosis. Aortic stenosis is problem with the main valve which lets the blood out of the heart and that's called the aortic valve. The Aortic valve can be affected by many processes and the usual ones which cause aortic stenosis are either a congenital problem with aortic valve which patients often refer to as a heart murmur that they've had all their life and eventually leads to the calcification and tightening of the valve or sometimes they have a rheumatic heart disease as a child and that eventually leads to aortic stenosis or just age.
Most patients with aortic stenosis go on for years and years without really noticing a whole lot of symptoms and once the symptoms appear, usually average lifespan after the appearance of symptoms is about 2 years. So symptoms appear really late in the course of aortic stenosis so it's very important to catch aortic stenosis earlier to give them the best chance at treatment. What we recommend is the patients' primary doctors as soon as they hear a murmur and this is the first sign that they would notice is a murmur, then send them to a cardiologist or refer them to get an echocardiogram, which is really the best test to determined how tight the aortic valve is and how calcified it is. What are the treatment options? Unfortunately the only treatment for aortic treatment is surgical.
There's really no medication which can release the tightness or relieve the heart from the pressure that it's under so it's a mechanical problem and the same way you have a clogged up pipe in the house, you have to replace it, the valve is the same thing. You have to replace it, you have to go in there to cut it out and put a new valve in place and that's really the mainstay of treatment of aortic stenosis. It's surgical treatment and it's usually open heart surgery. But there's always subset of patients who just are not surgical candidates because they are too frail or maybe too old; they may have other issues like very bad lungs, their main arteries maybe too calcified to even be able to sow on it and cut it and open it, so these patients typically would have been considered inoperable but now we have this new procedure which is called the transcatheter replacement of the aortic valve which essentially allows us to intervene and replace these valves without cutting their chest open, without putting them in the heart lung machine, without doing open heart surgery. This is the first time that actually a valve has been mounted on a catheter and sent through the arteries up to the heart, instead of going from the outside, going from the inside of the artery and replacing the valve and this technology is been available and FDA approved for the last 3 months. We had a multi center trial across the United States Europe and Canada which started about 3 years ago and was ongoing for 2 years.
Once the results of that trial came out it showed that this type of procedure not only saves lives in otherwords, patients who otherwise would just with routine medical treatment would have died a year or two down the road, were surviving and their quality of life was good and their readmission rate to the hospital was much lower than if they were treated with medication. When this became availble to us I mean it was just marvelous to have a way to treat these patients who were essentially condemned to death so I was very excited the first one that I did, not only because I was able to do it but also because of the simplicity of it and how quickly it went and how well it went compared to a big open heart surgery.
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