Less invasive heart surgery

Stanford patient receives a new aortic valve without open-heart surgery

Sharon Kramer has always thrived on hard work. She and her husband run two hofbraus in the San Francisco Bay Area, plus two Italian restaurants and a boutique in Palm Springs, California. Between traveling from their home in Atherton, California, to the businesses, as well as visiting grandchildren, the 76-year-old is constantly on the move. At least until a year ago, when all that energy disappeared, and she started taking catnaps in her car.

“I’ve always been high energy, so when I was starting to get unusually tired, I just thought, ‘Well, getting older is finally catching up with me,’” she said. “I’d get up in the morning and be good for a couple of hours, but if I did too much, I would have to go back to bed.”

Eventually, disturbed by this unusual fatigue, along with some shortness of breath and a fainting episode in a department store, she went to see her Stanford doctors. Medical tests showed that she had severe aortic valve stenosis, a narrowing of the aortic valve, which is life threatening. She needed a new heart valve.

“At that point, I was facing open-heart surgery,” she said. “But I didn’t want to do that. I understood that they had to split my chest open and that recovery could be quite painful and take four to six weeks. There was just no way I could lie around recuperating that long.”

Another option

Fortunately for Kramer, her doctors were able to offer her a less invasive option: transcatheter aortic valve replacement. TAVR reduces the patient’s recuperation period because it eliminates the need to cut open the chest. Instead, physicians insert an expandable biological heart valve via a catheter and thread it, usually through a needle puncture in the groin, into an artery in the leg up through the aorta and down into the heart to replace the diseased valve.

“It can be wonderful for patients,” said William Fearon, MD, professor of cardiovascular medicine, who, along with other Stanford researchers, has been involved with several TAVR clinical trials. “TAVR is a less invasive way for repairing defective heart valves, with a better quality of life.”

TAVR was once reserved for patients at high risk of not surviving open heart surgery. But positive results from two recent clinical trials resulted in its approval for use in a broader, healthier segment of the patient population who need new aortic valves.

Aortic stenosis occurs in more than 5% of the American population older than 75, according to the American Heart Association. As the valve opening narrows, it restricts blood flow to the aorta, the body’s main artery, forcing the heart to work harder to pump blood throughout the body. In severe cases, it can cause fainting, chest pain, heart failure, irregular heart rhythms and cardiac arrest — and even lead to death.

The standard treatment has been to open the chest cavity and replace the aortic valve with a mechanical or bioprosthetic valve to improve blood flow. Last summer, after two randomized clinical trials revealed TAVR to be as good or even better for low-risk patients, the Food and Drug Administration approved two valves for such patients.

‘Well studied in patients’

“This procedure has been well studied in patients,” Fearon said. “We’ve done more than 2,000 — about six a week.” With all the practice and advances in equipment, the outcomes have continued to improve, he said.

Kramer said she was thrilled with the outcome. She said she’s able to travel and work with the same amount of energy she had prior to getting sick.

“There was hardly any pain involved,” she said. “When I got home within a day or two, I was walking up and down stairs. I think I stayed in bed the first morning, but within two days, we were out to dinner, and I had a margarita in front of me. It was that quick.”