Heart Surgery without Surgery

Cardiologists are talking about a major advance: A study suggests that many people with a bad aortic valve, the heart's most important gate, can avoid open-heart surgery and have a new one placed through a tube in an artery. There may be a problem — a higher risk of stroke — and nobody is sure about how long these valves will last.

The aortic valve can harden and narrow with age, making it difficult for the heart to push blood through it. Severe cases are treated with surgery to replace the valve, but that's risky for many older people who have this problem. Without an operation, half die within two years.

Through an artery in the chest a new heart valve is attached to a balloon and advanced across the narrowed, older, diseased heart valve. The balloon is inflated and the new valve left in place.

A test of this gentler treatment in people too sick for surgery improved survival, doctors reported last fall. The new study involved nearly 700 people eligible but at high risk for surgery. Their median age was 84, and they were randomly assigned to get valves replaced through surgery or the new way. Twenty-eight people refused treatment when they learned they had been placed in the surgery group.

In the end, both groups did very well. After one year, about 24 percent of the artery patients and 27 percent of the surgery patients had died — considerably fewer than doctors had predicted.

However, strokes were twice as common in the artery-treated group — 8 percent versus 4 percent.
AP / Marilyn Marchione at www.time.com. Picture by AP / Edwards Lifesciences.