A revolutionary heart procedure that has given cardiac patients a life-saving alternative to open heart surgery is now expanding to treat more patients. The Food and Drug Administration now allows intermediate-risk patients the option of having transcatheter aortic valve replacement, a minimally invasive procedure that replaces the aortic valve.
“Risk for open heart surgery is determined by a multidisciplinary group of physicians and coordinators,” said Dr. Jason Schultz, an interventional cardiologist who directs the TAVR program at Essentia Health-St. Mary’s Medical Center. “Previously, TAVR was approved for only high-risk patients who were not good operative candidates.”
Using a scoring system called STS, the group determines each patient’s risk of open heart surgery. An intermediate-risk patient has an STS of 3 or greater, meaning there is a 3 percent chance of a bad outcome from open heart surgery within a 30-day period. Before the FDA approved the expanded procedure, patients had to have a score of 8 or greater or be deemed a poor surgical candidate.
“TAVR represents a less invasive means of achieving the same goal as open heart surgery,” said Dr. Schultz. “And while surgery remains an option for intermediate-risk patients, the trial data suggests outcomes with TAVR are at the very least equivalent to surgery, and in some cases better with the TAVR procedure.”
TAVR uses a valve composed of pig or cow tissue, similar to surgically-placed heart valves, within a metal stent. The valve is delivered through arteries in the body via the groin, under the collar bone, or under the breast or ribs. Once inside the heart, the valve expands to about an inch in size and begins working immediately — all while the heart is beating.
St. Mary’s Medical Center is the only hospital north of the Twin Cities to offer heart patients this choice. Since St. Mary’s began offering TAVR in the fall of 2013, the Heart & Vascular Center has performed 157 procedures.