Endoscopic Heart Valve Replacement a Success

Patients who need an aortic valve replacement may soon not have to have major surgery. French cardiovascular surgeons have for the first time used an endoscope to conduct the procedure.

Dr. Marco Vola of the Department of Cardiovascular Surgery at the Centre Hospitalier Universitaire de Saint-Etienne, in France, published a report on the procedure in the latest issue of the Journal of Thoracic and Cardiovascular Surgery.

“It is the first time that a procedure of human valve replacement has been performed with a totally endoscopic approach,” Dr. Vola said.

The procedure, which was performed successfully on two patients, took a little over 100 minutes. Patients were put under general anesthesia during the operation.

The endoscopic procedure, dubbed TEAVR (totally endoscopic aortic valve replacement), has a faster recovery time and is less painful than traditional surgery. Using an endoscope is nothing new; it’s also a method that has been used for coronary artery bypass grafting and atrial septal defect repair.

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The procedure was made possible by new bioprostheses for aortic valves that are mounted on a compressible, self-expanding metal stent.

Though it is not yet ready to be rolled out to the mainstream, the procedure has the potential to decrease chest trauma for patients and improve their quality of life.

How Does TEAVR Work?

Vola said the procedure begins with a small incision in the sternum, followed by another in the thorax. Surgeons then implant the stent using an endoscope—an imaging device connected to a long, flexible tube.

Vola said that the procedure is flexible, because it can also be performed under direct view using a small incision to the chest, which is still less invasive than traditional valve replacement surgery.

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What’s Next for TEAVR?

There is still a ways to go for doctors to perfect the procedure. Dr. Vola said that endoscopic sizers, as well as second-generation bioprostheses, would simplify the process. Scientists could also use surgical robots.

In the future, Vola said, he hopes to decrease the amount of time it takes to perform the procedure as he fine-tunes the techniques.

Is everyone a candidate? No, said Vola. It’s limited to patients chosen for specific anatomical characteristics. Vola said that more enhancements could make it viable for larger populations. Also, when other advancements like bioprosthetic valves are available to replace other cardiac valves, a similar procedure could be used to perform other heart surgeries.

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