Has it mended? Many were shocked this week when it was announced that The Rolling Stones had to postpone their North American Tour. Seemingly indestructible front man Mick Jagger was told by his physicians that he needed to take a break from touring to receive medical treatment. It was reported on April 5 that the 75-year-old Jagger underwent successful transcatheter aortic valve replacement (TAVR) at an undisclosed hospital in New York City. Billboard was first to report the successful procedure, and later his representatives officially stated: "Mick Jagger has successfully undergone treatment. He is doing very well and is expected to make a full recovery." The Rolling Stones are expected to restart their No Filter Tour in July, but specific dates have not yet been announced. Valvular Aortic Disease and Valve Replacement As the population ages, aortic stenosis has become the most prevalent valvular disease in western countries. According to Bhatia, et al., the prevalence of aortic stenosis increases to approximately 10% in patients over age 80. "The severity of aortic stenosis increases with age, with one in eight people older than age 75 showing moderate to severe aortic stenosis." Chronic inflammation with subsequent calcification leads to valvular sclerosis, and ultimately to aortic stenosis. The risk factors for calcific aortic disease are the same as those associated with coronary atherosclerosis- age, male gender, smoking, elevated LDL cholesterol, hypertension, and metabolic syndrome. Common signs and symptoms of heart valve disease often relate to heart failure, which can be caused by heart valve disease. These signs and symptoms include: Heart murmur Unusual fatigue Shortness of breath, especially when with exertion or when lying flat Swelling in the ankles, feet, legs, abdomen, and veins in the neck Treatment Repairing or replacing a valve can prevent permanent damage to the heart and risk of sudden death. When possible, heart valve repair is preferred over heart valve replacement. Valve repair preserves the strength and function of the heart muscle. People who have valve repair also have a lower risk of infective endocarditis after the surgery, and they don't need to take blood-thinning medicines for the rest of their lives. However, heart valve repair surgery is harder to do than valve replacement. Also, not all valves can be repaired. Mitral valves often can be repaired. Aortic and pulmonary valves often need to be replaced. Heart surgeons can repair heart valves by: Adding tissue to patch holes or tears or to increase the support at the base of the valve Removing or reshaping tissue so the valve can close tighter Separating fused valve flaps Interventional cardiologists repair heart valves using cardiac catheterization. Although catheter procedures are less invasive than surgery, they may not work as well for some patients. Heart valves that cannot open fully (stenosis) can be repaired with surgery or with a less invasive catheter procedure called balloon valvuloplasty. This procedure also is called balloon valvotomy. During the procedure, a catheter with a balloon at its tip is threaded through a blood vessel to the faulty valve. The balloon is inflated to help widen the opening of the valve. The doctor then deflates the balloon and removes both it and the tube. Sometimes heart valves can't be repaired and must be replaced. This surgery involves removing the faulty valve and replacing it with a man-made or biological valve. Biological valves are made from pig, cow, or human heart tissue and may have man-made parts as well. These valves are specially treated to prevent rejection of the valve. Man-made valves last longer than biological valves and usually don't have to be replaced. Biological valves usually must be replaced after about 10 years, although newer ones may last 15 years or longer. Unlike biological valves, however, man-made valves require the patient to be on lifelong anticoagulants. Transcatheter Valve Therapy Newer, less invasive procedures for valve replacement are called transcatheter valve therapy. It is referred to as TAVR when it involves the aortic valve. In the procedure, a catheter is threaded into the heart, typically through the femoral artery, although other vessels in the abdomen, neck, or clavicle can also be used. TAVR has allowed patients deemed too high risk to undergo open valve replacement to have their diseased valve replaced. The catheter, which is fitted with a collapsed replacement valve, is positioned in the center of the diseased valve. A balloon is then inflated, expanding the replacement valve into place within the natural valve. The catheter is then removed. Sometimes a balloon valvuloplasty is performed prior to the valve insertion if a wider opening is necessary. Here is an illustrative video of the procedure: According to Bourantas and Serruys in their article Evolution of Transcatheter Aortic Valve Replacement, "Cumulative results from registries and large-scale studies have provided robust data about TAVR and demonstrated its efficacy in the treatment of patients with AS." But TAVR is not recommended for all patients. Dr. Michael Deeb, professor of thoracic surgery at the University of Michigan, says: "A potential TAVR candidate must have severe aortic stenosis and a three-leaflet valve (tricuspid aortic valve) versus a two-leaflet valve (bicuspid aortic valve)." Patients with endocarditis or aortic aneurysms are also not candidates for TAVR. Also, at the present time, TAVR is not approved for patients with mild aortic stenosis or low surgical risk, although recent trials support use in the latter. A number of trials are currently ongoing. In some patients, a replacement valve can push aside an old valve flap, blocking blood flow to the heart. The result -- coronary artery obstruction -- is a rare but life-threatening complication of TAVR, and the National Heart, Lung, and Blood Institute (NHLBI) researchers have invented a technique to prevent it. Called Bioprosthetic Aortic Scallop Intentional Laceration, it prevents Iatrogenic Coronary Artery obstruction (BASILICA), the procedure involves using an electrified wire inside a catheter to split the existing valve flap before placing the new valve. Without this technique, replacing a faulty valve would be too risky for these patients. The NHLBI study, led by Drs. Jaffar Khan and Robert Lederman, tested the BASILICA procedure on seven gravely ill patients who qualified for compassionate use of the technique, which had been previously untested in humans. Dr. Lederman reported, "All patients had a successful TAVR with no coronary obstruction, stroke or any major complication. They were doing well as they reached the 30-day-mark after the procedure." A NHLBI funded study to expand the procedure is currently underway. Source
