Hartford Business Journal

8 Hartford Business Journal • July 30, 2018 • www.HartfordBusiness.com FOCUS: Health Care By Matt Pilon mpilon@HartfordBusiness.com T he options for treating heart ailments that arise in old age have taken a big leap forward in recent years. One of the more significant developments has been a minimally invasive valve replacement procedure approved by the U.S. Food & Drug Administration about seven years ago. Area doctors say transcatheter aortic valve replacement, known by its acronym TAVR, has prolonged older patients' lives and become a significant line of business for larger hospitals. "It represents a major market going forward for healthcare systems and a major way of helping a lot of people who would otherwise be dying from their heart condition," says Dr. Ray- mond G. McKay, co-director of the Heart & Vascular Institute structural heart program at Hartford Hospital, which has performed nearly 900 TAVR procedures since 2012. The pace of surgeries could increase if and when the FDA approves the procedure — each of which brings in $50,000 to $60,000 to Hartford Hospital — for additional types of patients. TAVR allows interventional cardiol- ogists and cardiothoracic surgeons to replace the crucial and hardworking aortic valve without the use of open- heart surgery. Instead, doctors guide a metal-mesh enclosed replacement valve made from a pig or cow heart through a key artery, most often from the groin up to the heart. The replacement valve fits snugly within the existing worn out or calcified valve, which is not removed during the procedure. The increasing use of TAVR doesn't mean open-heart surgery is falling out of favor. For many patients with worn- out valves (a condition known as aortic steno- sis) it's been the clear choice for decades and will have its place for years to come. But surgery isn't an option for roughly two- thirds of patients with severely worn-out valves, largely those who are older — typi- cally in their late 70s or 80s — and frailer. That leaves those patients — particularly indi- viduals showing severe symptoms that could lead to death — with few options. That "extreme- risk" population is the biggest ben- eficiary of TAVR. The survival rate for high-risk pa- tients who had a transcatheter aortic valve replacement was 70 percent a year after surgery, according to one trial. That was better than the 50 percent survival rate for high-risk patients who received non-surgical medical therapy like diuretics — a Heart Saver Hartford docs helping study pros, cons of heart valve replacement breakthrough Pros, cons and unknowns: TAVR vs. open-heart surgery Doctors and researchers have learned much about transcatheter aortic valve replacement (TAVR), but there are still questions studies seek to answer. Mortality risk The higher risk the patient, the more benefi- cial TAVR is to lifespan. TAVR can be the sole option for sicker patients. Recovery Patients recover more quickly from TAVR than open-heart surgery, which requires an- esthesia, intubation and cutting the sternum. Cost TAVR valves are pricier, but follow-up care can be less costly. Durability Open-heart surgery valves are known to last 10 to 15 years or even 20 years. TAVR valves haven't been tested for those lengths yet. Stroke While both are relatively low, TAVR stroke rates can be higher than open-heart surgery. Pacemaker A greater portion of TAVR patients must use a pacemaker afterwards. Leakage While valve leakage is uncommon, TAVR valves have had higher leak rates than open- heart surgery valves. At Hartford Hospital, interventional cardiologist Dr. Francis Kiernan holds a TAVR heart valve, which is compressed to the size of a pen cap when its guided through a patient's artery and up to the heart. With him are his counterpart Dr. Raymond McKay (left) and APRN Lauren Curtis. HBJ PHOTOS | STEVE LASCHEVER

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