Inoperable patients with severe symptomatic aortic stenosis have survival rates as low as 50 percent within two years of symptom onset. A team of Washington University cardiac surgeons and interventional cardiologists at Barnes-Jewish Hospital has developed unique expertise in a new technology— percutaneous aortic valve replacement— that makes AVR an option for these high-risk patients.
As one of the top 10 enrollers in the PARTNER (Placement of AoRTic traNscathetER valves) Trial, the team of physicians has performed more than 70 transcatheter aortic valve replacements since 2008 using the Sapien valve by Edwards Lifesciences.
The valve, made of bovine tissue sewn into a collapsible metal stent, is delivered via catheter, and balloon-expanded within the diseased valve. Positive results from the first cohort of the trial point to approval in 2011 for femoral artery delivery of the device. The complex procedure, which can be accomplished either transfemorally or transapically, is best done in a hybrid OR, and requires the integrated skill and collaboration of a surgeon, interventionalist, echocardiographer and anesthetist. Only 23 centers in the United States met selection criteria for the pivotal randomized clinical study.
Because the approximately one-hour procedure does not subject the patient to the stress of conventional open-heart surgery, valve replacement has become a treatment option for patients with severe aortic stenosis.