New method for safer valve replacement

Scientists have developed a new and safer technique to prevent coronary artery blockage during coronary valve replacement (TAVR), a rare but often fatal complication.

This method is called Biological Endoscopy to prevent coronary artery blockage (BASILICA) . It will increase treatment options for high-risk patients who need heart valve procedures.

TAVR, a procedure used to treat aortic stenosis, consists of a flexible, long, thin tube called a catheter, through the femoral artery in the leg to the heart. Aortic stenosis is a fatal narrowing of the valve that controls blood from the heart to the rest of the body. This narrowing reduces blood flow to vital organs, resulting in shortness of breath, chest pain, fainting and heart failure.

For elderly or weak patients, TAVR provides a more effective and less invasive alternative than cardiac surgery. However, a small group of these patients may be blocked by coronary arteries during TAVR. For more than half of patients with coronary artery obstruction in TAVR, this complication has been fatal.

Aortic stenosis is a fatal narrowing of the valve that controls blood from the heart to the rest of the body.

BASILICA was developed by Dr. Jaffar M. Khan of the National Heart, Lung and Blood Institute (NHLBI), a division of the National Institute of Medicine (NIH), to increase the safety of TAVR for this group of patients. .

Dr. Robert J. Lederman, senior researcher at the NHLBI's Resident Research Division, who is in charge of research with Dr. Khan, said : "These patients are either not eligible for normal TAVR, or they have high risk '.

Lederman explains that in TAVR, the surgeon places a catheter inside the heart and uses a balloon to open a new valve inside the aortic valve. However, in some patients with irregularly structured hearts, such as large heart valve leaves or small aorta roots, large heart valve leaves prevent blood flow to the coronary arteries when New valve system opens.

"There is no good treatment or prevention for coronary artery obstruction caused by TAVR. The technique of using stents previously to open coronary arteries seems to have a long-term result that is not good." Lederman said.

BASILICA offers solutions for coronary artery problems during TAVR. The cardiologist intervened an electric wire that was activated by the size of a sewing thread through the catheter and used it to divide the root into two, so it could not block the coronary arteries after it. was pushed to the left of the heart valve by the catheter.

In the current study, the researchers reported the success of the BASILICA procedure in seven severely ill patients who were eligible to use the technique - not yet tested in humans - because there were no options. choose other care.

"All patients have successful TAVR without clogging blood vessels, strokes or any major complications , " Lederman said. "They were fine when they reached the milestone of 30 days after surgery."

Researchers hope this technique will eventually help reduce the number of deaths from heart valve disease. According to the American Heart Association, about 5 million people in the United States are diagnosed with heart valve disease every year, and more than 20,000 people die.