Less-invasive heart valve replacement tied to better quality of life

(Reuters Health) - People who get minimally-invasive surgery to replace damaged heart valves have an easier time completing daily tasks and a better quality of life after the procedure, a research review suggests.

The analysis focused on people with what’s known as aortic stenosis, which occurs when the large blood vessels leading away from the heart narrow, forcing it to work much harder to pump blood. The condition tends to develop with age and can lead to chest pain, shortness of breath, fatigue and heart failure.

Patients in the study had minimally-invasive surgery that fixes the problem by inserting a replacement valve to send blood around the damaged valve while leaving it in place. This procedure, known as a transcatheter aortic valve replacement, is done by threading a catheter to the heart through a small incision in the chest or from the large artery in the groin - it doesn’t require cutting open the chest.

Afterward, patients could walk significantly further in six-minute walking tests used to assess their functional capacity. On average, they added almost 42 meters (138 feet) to their performance before surgery.

In addition, patients reported clinically meaningful improvements in their quality of life and their ability to complete daily tasks after surgery.

The results offer fresh evidence that transcatheter aortic valve replacement can help ease symptoms like shortness of breath and fatigue that limit the ability to handle physical exertion, said Dr. David Cohen, director of cardiovascular research at Saint Luke’s Mid America Heart Institute in Kansas City, Missouri.

“These symptoms lead to reduced functional capacity (inability to perform physical exertion) and also impact a patient’s overall sense of wellbeing and quality of life,” Cohen, who wasn’t involved in the study, said by email.

“By replacing the diseased aortic valve, transcatheter aortic valve replacement (and surgical valve replacement) reverses these effects and generally allows the patient to return to his or her ‘normal’ quality of life - limited only by the impact of other conditions that the patient may have,” Cohen said by email.

Overall, the current analysis included 2,775 patients from a total of 20 previously published studies on outcomes for this type of surgery.

Participants were 82 years old, on average, and they were typically considered high-risk surgical patients due to either advanced age or other medical issues.

The smaller studies in the analysis ranged in size from 36 to 484 patients, and most of them followed patients for as long as six to 12 months after surgery.

One limitation of the current analysis is that many of these smaller studies were not controlled experiments designed to prove whether or how transcatheter aortic valve replacement might improve quality of life, lead study author Nicola Straiton of the University of Sydney and colleagues note in Age and Ageing. Straiton didn’t respond to emails seeking comment.

People who don’t get this type of minimally invasive surgery may instead get a more invasive procedure that involves surgeons cutting open the chest to repair a damaged valve.

Surgeons may also perform what’s known as angioplasty, which uses a catheter to insert a tiny balloon and inflate it to open the valve; sometimes surgeons will also insert a stent, or tiny wire mesh cage, to keep the artery propped open.

Results of the current study reaffirm that a minimally-invasive procedure can be a viable option, even for elderly people who are high-risk surgical patients, said Dr. Samir Kapadia, a cardiovascular medicine researcher at the Cleveland Clinic in Ohio.

“Replacing the aortic valve improves functional capacity,” Kapadia, who wasn’t involved in the study, said by email. “Transcatheter aortic valve replacement is an important minimally invasive treatment option for replacing the aortic valve that is narrowed.”

SOURCE: Age and Ageing, online January 25, 2018.