New way to plug leaky heart valve

At age 90, retired Air Force Brig. Gen. Thomas Woods wasn't a candidate for the ordeal of surgery to replace his failing aortic valve — even though he remains pretty spry.

“It had deteriorated to such an extent that they were worried that I might have a heart attack,” Woods said Friday. “It became more essential that I get something done.”

The previous day, Woods and a second patient underwent a less-invasive valve replacement procedure at University Hospital, one just approved by the Food and Drug Administration in November.

Using a similar technique as balloon angioplasty, doctors threaded his new valve through an incision near his groin to his heart, and squeezed it in place alongside the failing valve.

The procedure, known as transcatheter aortic valve replacement, or TAVR, has generated some enthusiasm among doctors and patients because it offers a new option for many deemed too sick or frail to have their chests cracked open.

But it has also raises concerns that healthier patients — and their doctors — may be tempted to seek the less invasive procedure. A consensus statement from several surgical groups released earlier this year urged that patients be selected carefully, and that the open procedure is safer for those who can tolerate it.

“For patients who are good candidates for low-morbidity, low-risk open surgery, the technology today is still better with open surgery,” said Dr. A.J. Carpenter, director of cardiothoracic surgery at the University Health System. “For patients that are very high-risk, then the technology is certainly better with a TAVR.”

Dr. Steven Bailey, chief of cardiology at the University of Texas Health Science Center, who performed the procedures and who helped write the consensus statement, said the need is great.

“Roughly four in every 100 adults over the age of 75 have either severe or critical aortic stenosis,” Bailey said. “Traditionally it wasn't felt they would benefit from therapy. So although there are roughly 50,000 aortic valves (replaced) surgically every year in the United States, there are additionally a large number of individuals who are not offered therapy at all.”

TAVR is not without risk. Even before it's inflated by a balloon, the tube carrying the new valve is thick and can damage blood vessels. And there's an added risk of major stroke. About 5 percent of patients die within 30 days, studies show.

And it's not cheap. A study published in February estimated the cost of the operation, including the procedure, doctor fees and hospitalization, as $78,542, as opposed to the New York Times' estimated cost of about $50,00 for the open procedure. Medicare is still trying to decide whether to pay for it.

But Bailey noted the risk of dying is high for patients who rely only on medicine or even a balloon catheter alone to stretch the faulty valve — 50 percent within two years after symptoms begin.

“Once a patient has symptoms of aortic stenosis, which can include being dizzy, being short of breath, being unable to perform usual activities and having pain in their chest — they live with heart failure and they live miserably,” Carpenter said. “Anything we do to relieve those symptoms is a big benefit.”