Central Maine Heart and Vascular Institute was a participant in a recent national trial that could change the way many heart patients are treated, finding that catheter-guided aortic valve replacements perform better than open-heart surgery in low-risk patients who normally would undergo the more invasive procedure.
CMHVI was the only Maine medical center included in the study, published this week in the New England Journal of Medicine. Seventy-one medical centers and 1,000 patients participated in the trial of trans-catheter aortic valve replacement (TAVR), which is a less invasive option for patients too frail to undergo surgery. The procedure, where doctors thread a catheter through a groin artery in the heart and install a new aortic valve, has become common over the last decade especially for this subgroup of heart patients. What doctors did not know is how the many low-risk patients—strong enough for surgery but offered this lower-impact option instead—would fare with the procedure. The study found that one year after the procedure, the rate of death, stroke or re-hospitalization among these patients was significantly lower than with surgery. Hospital stays were shortened, too.
There are an estimated 5 million adults in the United States with aortic stenosis — a buildup of calcium in the aortic valve that can lead to heart failure. The new study suggests that open-heart surgery may be required for many fewer patients going forward.
“It’s absolutely going to change things,” said Dr. Andrew Eisenhauer, medical director of CMHVI. “Those people familiar with the subject will tell you that this will be the method of choice for most patients who need an aortic valve replacement.”
Eisenhauer noted that more long-term studies need to be done—this trial only studied TAVR patients one year out from the procedure—and that for patients with congenital deformities of the aortic valve, or very young patients, TAVR may not be appropriate. Previous studies looked at outcomes for medium and high-risk patients, he said.
CMHVI, has done 181 TAVR procedures since 2015. Recently, CMMC was recognized by IBM/WatsonHealth as one of the nation’s top 50 hospitals for cardiac care. Affiliated with Massachusetts General Hospital and staffed with highly experienced physicians, CMHVI offers advanced heart and vascular care to patients from across Maine and a unique team-based approach, with interventional cardiologists and surgeons working together to treat each case in a comprehensive way.
“The important thing for patients to remember as they are selecting their care team, is that the interventional cardiologists and the surgeons should be working together,” Eisenhauer said. “Together and with the patients, they should be able to determine the best route—surgery, TAVR, or other treatment, for each person.”