SNOWMASS, COLO. – Familiarity with the option of minimalist transfemoral transcatheter aortic valve replacement is causing some top surgeons to broaden their use of nonsurgical valve replacement.
"This minimalist transfemoral TAVR is something we’ve done quite a lot of. As a surgeon, I sort of hate to say it, but this to me has made a huge difference in whether I make a patient surgical or transcatheter," Dr. Vinod H. Thourani said at the Annual Cardiovascular Conference at Snowmass.
Dr. Vinod H. Thourani
"It’s me and a cardiology resident doing a minimalist transfemoral TAVR in the cath lab in an awake patient with fentanyl and Versed [midazolam] and a 14- to 24-French sheath. There’s no incision and the patients don’t go to the ICU. Thirty to forty percent of them go straight to their private room after their valve is implanted, if their groin is okay in the postop cath lab area," explained Dr. Thourani, associate director of cardiothoracic surgery at Emory University, Atlanta.
In 200 patients who’ve undergone the procedure at the hands of Dr. Thourani and his Emory colleagues, there has been zero in-hospital mortality. Most patients are home in 2-3 days.
On the other hand, the surgical approach is seeing advances as well, he continued. One technologic development he’s particularly enthusiastic about is the surgical sutureless valve.
"This is a whole new class of valves. My cardiologists, when I call them and tell them I put a sutureless valve in their patient, have no clue what we’re talking about," according to the surgeon.
Two major U.S. clinical trials are ongoing for the investigational sutureless Sorin Perceval and Edwards Intuity valves. These truly sutureless valves are crimped. The surgeon performs an open sternotomy, cross clamps the aorta, makes an aortotomy, then telescopes the valve down through the aortotomy. The Intuity valve is deployed via a brief balloon inflation to size it properly. The Perceval valve contains nitinol, so all that the surgeon has to do is put warm saline on it and the valve starts working.
"On my last Edwards Intuity valve, just last week, the cross clamp time was 35 minutes. Just to give you some perspective, the cross clamp time for a stented valve is 60-65 minutes and about 90 minutes for a stentless valve," Dr. Thourani explained.
He serves as a consultant to Edwards Lifesciences, Sorin, and St. Jude Medical.