Stanford Medicine Newsletter Updates For the Local Community

 

Replacing aortic valves without major surgery

   

At age 58, Laura Hosking was unusually young to be in need of a new aortic heart valve. But her situation was not typical: As a teenager, she had received treatment for late-stage Hodgkin's lymphoma, including full-body radiation, which put her at risk for problems with her heart and other disorders later in life.

A finance professional and mother of three, she began to feel the long-term effects when she was in her 40s. She tired easily and had difficulty walking and carrying groceries. She could no longer play her usual 18 holes of golf. As her condition worsened over the years, she sought the help of Stanford Medicine cardiologist Randall Vagelos, MD, who found that she was suffering from aortic stenosis, a narrowing of the aorta, which carries blood from the heart to the rest of the body. Her health was further compromised by the discovery in 2013 of lung cancer, which was brought under control with a combination of CyberKnife radiotherapy and localized surgery.
New alternative

Given these factors, Vagelos knew that Hosking might not be able to withstand open-heart surgery, so he offered her the option of a relatively new, minimally invasive heart valve procedure known as TAVR, or transcatheter aortic valve replacement. The procedure is considered by many in the field to be a game-changer. It was approved by the U.S. Food and Drug Administration in 2012 for use in patients who, like Hosking, are considered at high risk of complications or death from open-heart surgery.

"She had a fairly complex history going into the procedure, which made for a heart-team decision favoring the non-open surgical approach to her valve," Vagelos said. "An open surgical approach to valve replacement in a patient so young is still the gold standard because a mechanical prosthetic valve can last a lifetime. But the global damage to her chest from childhood radiation made a non-open surgical approach to her aortic valve disease more attractive."

Laura Hosking is back to playing golf after a minimally invasive procedure to repair her aortic valve.

   

Faster recovery

In a traditional aortic valve procedure, surgeons open the chest and use a heart-lung bypass machine to temporarily stop the heart, then remove the damaged valve and replace it with a new one. With TAVR, the new valve is compressed inside a thin catheter, which is inserted into a blood vessel in the leg, then threaded up through the aorta and into the heart. The new valve then is released from the catheter and expanded with a balloon. Once in place, it begins working immediately.

Patients usually recover after two or three days in the hospital, compared with five to seven days for open-heart surgery. Hosking, who was younger than a typical TAVR patient, recovered even more quickly. She was walking and talking the day after her procedure and was back home within two days. She had grown so accustomed to taking shallow breaths for years that she had to retrain herself to breathe normally, she said.

"TAVR gave me back my life in an immediate and profound way," Hosking said. Today, she has returned to playing golf and clocking 10,000 steps a day. She continues to see her team at Stanford to monitor her new valve and her lungs and said that she is immensely grateful to her medical team. "Every birthday is such a gift," she said.

Stanford Medicine doctors have performed more than 1,000 transcatheter aortic valve replacements, and Stanford Hospital is one of a handful of hospitals in Northern California to offer the procedure. Multiple studies have confirmed TAVR's effectiveness in treating patients at intermediate to high surgical risk, and Stanford clinicians are continually evaluating more patients as potential candidates for the procedure. The Stanford team is also studying the use of the approach in patients at all risk levels who have asymptomatic aortic stenosis.

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