Cutting-edge cardiac fixes
Transcatheter aortic valve replacement (TAVR)
What it is: The transcatheter aortic valve replacement is a new procedure to treat aortic stenosis, a narrowing of a major heart valve that blocks blood flow and causes your heart to pump harder. The procedure, commonly called TAVR, is an alternative to open-heart surgery for a valve replacement. Doctors puncture a patient’s artery, often through the groin, and guide a collapsed replacement valve to the aorta where it is placed inside the patient's old aortic valve. A TAVR is a 30- to 40-minute procedure and a patient can return home within two days. A traditional surgical replacement is three hours long and includes a hospital stay of five to eight days if all goes well, said Dr. Mark J. Russo, director of the Center for Aortic Diseases and director of Cardiothoracic Surgery Research for Barnabas Health System.
History: Created in 2002 in France. Approved by FDA in November 2011.
Number of procedures: More than 26,400 TAVRs have been conducted through 2014 in the United States, according to a recent report from the Society of Thoracic Surgeons. Another 280,000 have been done worldwide.
Who it helps: The procedure has been approved for patients who otherwise wouldn't be able to undergo a traditional valve replacement surgery as well as those who are at a high risk for the surgery. Doctors are hopeful the FDA will approve the procedure for patients at intermediate risk later this year. Clinical trials on patients at low risk for traditional valve replacement surgery are planned.
"I think in, say, the next three years, TAVR is going to completely replace (traditional valve replacement surgery)," Russo said.
Cardiac surgery? There's a robot for that
Leadless pacemakers
What it is: Clinical trials are underway to test a new pacemaker that is 2.5-centimeters long — about the size of a AAA battery — and does not require the wires, called leads, that attached to the heart with traditional pacemakers. The new pacemaker is also significantly smaller than older model pacemakers, which is about the size of a half dollar, not including the wires, said Dr. Ashish Patel, director of Electrophysiology Services New Innovations for Meridian. The new, smaller pacemaker is inserted via a small incision in the shoulder while the old pacemaker required a surgery, Patel said. The clinical trial is being performed at 50 sites internationally, including Jersey Shore University Medical Center, the only New Jersey location.
History: Still in clinical trials. FDA has not yet approved the device for sale.
Number of procedures: 15 patients living in Monmouth and Ocean counties are participating in the clinical trial at Jersey Shore University Medical Center.
Who it helps: Patel said he expects the leadless pacemaker to be the preferred device for patients in the future.
5 questions to ask your doctor
High-tech heart imagery
What it is: Thanks to breakthroughs in echocardiography, nuclear imaging, cardiac computed tomography (CT), and cardiac magnetic resonance (CMR), doctors can see inside a heart like never before. The stunning detail these imaging technologies provide has greatly reduced the need for exploratory surgery. It’s also opened the door to new minimally invasive procedures ranging from routine angiograms to complex heart valve replacements.
History: CT, PET and MRI technologies date to the 1970s, but in recent decades the digital revolution has dramatically improved image quality and detail. More recently, doctors have been using intricate models of their patients’ hearts produced by 3-D printers to prepare for complicated surgeries. Meanwhile, researchers at the Wake Forest School of Medicine are printing out artificial heart cells called Organoids that actually beat.
Number of procedures: Not available
Who it helps: More than 85 million Americans with some type of cardiovascular disease. However, medical experts caution that CT scans and other types of imagery can be overused and may expose patients to potentially dangerous amounts of radiation.
The Watchman
What is it: An atrial appendage closure device. Developed by Boston Scientific, it’s a tiny mesh cage that fits over the opening to the left atrial appendage, where most blood clots are believed to occur. To watch an animation of how it works, click here.
History: FDA approved in 2015.
Number of procedures: Not publicly disclosed. Used in more than 100 heart facilities in the U.S.
Because it disrupts the heart’s ability to pump blood to the rest of the body, atrial fibrillation, or A fib, greatly increases the risk of heart attack, stroke and death.
Who it helps: Patients with atrial fibrillation who want an alternative to longterm warfarin (blood-thinner) use. In a clinical trial, 92 percent of patients were able to come off warfarin after 45 days, and 99 percent were off within one year.