Not too long ago, a diagnosis of severe aortic stenosis heart valve disease was a death sentence for many seniors. Within the past year, that has changed dramatically.
Aortic stenosis is "a hardening of the aortic valve, which means the valve cannot open in a normal fashion," says Dr. Martin Leon, director of the Cardiovascular Interventional Therapy program at New York-Presbyterian Hospital / Columbia University Medical Center. It is a common disease of aging: About 300,000 older Americans have the condition. "There is no medication you can take that's going to make a difference," Leon says.
Until recently, open-heart surgery to replace the defective valve was the only effective treatment. Without valve replacement surgery, the average survival rate is two to three years once a person begins to display symptoms, typically shortness of breath and chest pains.
About a third of seniors with aortic stenosis were not considered candidates for the arduous surgery because they were too frail or had other health problems.
"When we're dealing with an increasingly elderly population of patients that have many other medical conditions, then the open [heart] surgery is problematic," Leon explains. "So we developed a way to transplant the valve without opening the chest."
About a year ago, the FDA approved a less-invasive valve replacement surgery pioneered by Leon and his team of surgeons. New York-Presbyterian has performed about 600 of the procedures, known as TAVR. The surgery is especially recommended for those who, in the past, were deemed inoperable because of fears they wouldn't survive open-heart surgery.
While New York-Presbyterian was at the forefront of TAVR, other hospitals have adopted the procedure. "Almost every major center here on Long Island is doing one version of these TAVR procedures," says Dr. Jean Cacciabaudo, chief of cardiology at Southside Hospital in Bay Shore and president of the board of the Long Island Region of the American Heart Association. "You're out of the hospital in two to three days, and back to life without that prolonged -- typically three-month -- recovery of open-heart surgery."
But if primary care physicians are not aware of the new procedure, they may not refer prospective candidates because they believe the patient is too old.
"I think the threshold for referral needs to be adjusted and reviewed," Leon says. "The community standard is that when you're a certain age, you're not given the opportunity to consider options that might have a significant effect on prolonging life and improving quality of life."