For patients with structural heart disease, a rise in the availability of minimally-invasive procedures gives significant cause for hope. They go by these acronyms: TAVR and TMVR
That’s especially the case for older patients or those who have already had an open-heart procedure in the past and may be too weak for an additional open-heart surgery, said Dr. Samuel Turner, an interventional cardiologist at Novant Health Cardiology in Winston-Salem. Now, said Turner, many patients fitting that profile often have options to get heart repairs that can add quality years to their lives.
Cardiovascular disease, in general, remains the leading cause of death in the U.S. It’s responsible for 1 in every 4 deaths, killing more than 600,000 people per year .
Two potentially good options
One of these procedures is TAVR, (transcatheter aortic valve replacement) used for the treatment of aortic stenosis. That’s a narrowing of the aortic valve, which connects the main pumping chamber of the heart – the left ventricle—to the body’s main artery, the aorta.
Another is TMVR (transcatheter mitral valve repair) for a different heart condition, mitral regurgitation, also called leaking of the mitral valve. The mitral valve lets blood flow from the left atrium heart chamber to the left ventricle.
The advantage of less-invasive
In the past, open-heart surgery was the only option available for aortic stenosis and mitral regurgitation. But many older patients or others with weakened hearts could not receive that treatment because their condition made it too risky.
“With open-heart surgery, we have to open the chest, stop the heart, put the patient on a heart-lung machine, repair or replace the valve and then close the patient’s chest. That’s about a 3 or 4 hour operation with up to six weeks for complete recovery,” Turner said.
“Instead, with a TMVR procedure, for example, we put a small tube in the groin blood vessel and the procedure takes about two hours,” said Turner. “The patient spends one to two nights in the hospital and then goes home and the recovery is a lot easier on the patient than open-heart surgery.” TAVR is also performed through an incision in the groin.
It’s not unusual for patients in their late 80s or in their 90s to have the TAVR or TMVR procedure. And both procedures are widely predicted to increase in coming years in the U.S., particularly as baby boomers age and the procedures continue to become more widely available.
The number of TAVR procedures in the U.S. increased from about 4,600 in 2012 to about 25,000 in 2015. Novant Health has completed more than 250 TAVR procedures at Novant Health Forsyth Medical Center in Winston-Salem since it began performing them in 2013. Novant Health’s Heart and Vascular Institute also recently celebrated 100 successful TAVR procedures in its Charlotte market earlier this year.
TMVR, meanwhile, may be on its way to growth similar to TAVR.
‘Front door’ vs ‘back door’
While “TAVR” and “TMVR” sound the same, Turner said patients need to understand the two conditions are very different. He said the second letter in the acronyms refer to the respective valves: aortic and mitral.
Turner calls the aortic valve the “front door” of the heart and the mitral valve the “back door.” When the heart beats, he says, blood should go out the front door (the aortic valve), not the back door (the mitral valve).
When the mitral valve is leaking, “Blood will back up into the left atrium and the left atrium back up into the lungs,” Turner said. “That’s why patients typically get short of breath when they have a leaking mitral valve.”
MitraClip is currently the only FDA-approved TMVR device and has been used on more than 50,000 patients worldwide. The clip is the size of a dime and is clipped onto a leaking valve like a small clothespin to repair it, keeping the valve from leaking.
Repair vs. replace
TAVR, (rhymes with "gather"), involves feeding a replacement mesh valve into the heart, via an incision in the groin. The procedure, which takes about an hour, places a new valve into the existing valve’s place without having to remove the existing valve.
The “R” in the two acronyms, TAVR and TMVR, is another differentiator. The “R” in TAVR stands for “replacement” (even though the old valve is not removed) while for TMVR MitraClip procedures, a clip is being placed on the mitral valve for a “repair” and nothing is being replaced.
The one similarity between aortic stenosis and mitral regurgitation, according to Turner, is patients will often show congestive heart failure (CHF) symptoms. Turner said signs of congestive heart failure include shortness of breath on exertion, waking up at night gasping for air, shortness of breath when lying flat and swelling in the legs.
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Dr. Turner discusses TAVR and TMVR from Novant Health Healthy Headlines on Vimeo.