New Procedure Approach Could Improve Heart Disease Treatment

Transcaval access could allow high-risk patients to receive surgical intervention for aortic valve stenosis.

Researchers recently created a new, less invasive method for performing transcatheter aortic valve replacement in patients with aortic valve stenosis, a fatal heart condition.

The new method, transcaval access, will make the procedure available to high-risk patients, including women whose femoral arteries are too small or diseased to undergo the procedure, according to the study published by The Journal of the American College of Cardiology.

Aortic valve stenosis is a condition where the heart’s aortic valve is narrowed, which then reduces blood flow, and makes the heart work harder. This condition causes the heart to weaken, and leads to chest pain, fatigue, and shortness of breath.

Transcatheter aortic valve replacement involves inserting a stent into the artery to normalize blood flow, but the artery is not removed in this procedure.

For a majority of patients, physicians will perform this procedure through the femoral artery in the leg, but for 15% of patients, they must find an alternative route. A common alternative is through the chest, which involves invasive surgery and complications.

The new method involved electrifying a small wire so it crosses between neighboring blood vessels in the abdomen, according to the study. It can also be performed in patients who are awake.

However, physicians have previously said this method was dangerous since it requires creating large holes in the abdominal aorta and the inferior vena cava, increasing the risk of fatal bleeding.

The method, created by researchers at the National Heart, Lung, and Blood Institute, was tested in a trial of 100 patients with aortic valve stenosis, and was determined to be successful in 99 of the patients.

Despite the fact that this procedure may not be widely supported by physicians and surgeons due to perceived risks, the method was created to address a specific need for patients who have limited treatment options.

The mechanism of action is that bleeding from the aorta decompresses into a corresponding hole created in the vein since the surrounding area behind the peritoneum has increased pressure compared with the vein, according to the study.

Findings from the study were confirmed by a committee of cardiologists not involved with the trial. The review discovered that the procedure has a high success rate, and acceptable rates of bleeding and vascular complications.

These most recent findings build on previous trials conducted in animal models in 2012.

“This is a seminal study,” said the lead author, cardiologist Adam B. Greenbaum, MD. “It challenged conventional wisdom, which objected to the idea of safe passage between the vena cava and the aorta. More important, it is the first of many non-surgical minimally-invasive tissue-crossing, or so-called transmural catheter procedures developed at NIH that can be applied to diverse fields of medicine.”