Well, I have also heard the talk, but at best appears quite a few years off.
What I am hearing, is more and more of a "less invasive" surgery for AVR. I was listening to two surgeons from NYU on DR Radio, discussing with a patient who had this sugery, (his third), and was up and shopping 4 days after surgery! Really impressive stuff.
I hate to burst your or anyone elses bubble, but I was up and shopping 4 days after my full sternotomy AVR. Before this transcatheter method becomes common place, if it does, the tools and techniques, not to mention the design of the valve will likely go through some major modifications. It will have to perform well enough so that younger recipients can lead the same kind of lives that would be available had they received traditional surgeries; there will have to be similar durability numbers and that will take a decade or two given that traditional valve replacements, in most cases, last at least that long; and I believe the transcatheter implanted valve has to be a smaller size in many cases so that it will fit in position leaving open the possibility of ____________ mismatches (prosthesis/patient?) as well as other hemodynamic limitations. Those are among the reasons why these surgeries are onle being performed on very weak or ill patients. I am hoping a less invasive type of surgery is available when I'm ready for my next AVR, but right now, I'm counting on a full sterno. I am optimistic that knowledge, practices, equipment and staff will be even more advanced at that point that my probability for a complete and healthy recovery wll be even better than if I were to have the surgery tomorrow. I believe that's a more realistic expectation for a decade from now.
I think it will be a few years before it is common especially for 1st time replacements, and they will continue to modify the valve and delivery system especially as more companies get into making them. of course like all invasive medical procedures their is always a risk. And I am sure they will never be able to completely do away with Tradional valve replacements. IMO it will probably be like CABGs now how manay patients are able to avoid OHS by having stents placed, but many patients are not candidate for stents so must have traditional bypass surgery.
All ready the corevalve is on its 3rd generation and one of the bigger improvements is the sheath has gone from 8mm to 6 which helps deliver the valve with less damage, one of the companies (forget which right now) is also working on making it repostional. The work they are doing on transapical placemtn should help with some of the issue transfemeoral have because of small, fragle veins arteries.
The pulmonary valve (which has less pressure) has the longest record, and that has mainly been used in children/young adults (who already had at least 1 replacement and they are able to be just as active as the patients with tranditions valves. In Europe , France they have been using them for a decade in the earliest cases and most are still going well (and children/young adults are the group that usuall calcifies/outgrows valves/conduit quickiest, They also have already successfully replaced a percutaneous valve with a new one. Obviously you can't keep replacing valves inside older valves, but even if perctuaneous valve replacements cuts down on the number of OHS these children/adults have to go thru that is a HUGE blessing.
I'm not quite sure what you mean with this "and I believe the transcatheter implanted valve has to be a smaller size in many cases so that it will fit in position leaving open the possibility of ____________ mismatches (prosthesis/patient?) as well as other hemodynamic limitations." But how I understand it, is since the leaflets are sewn right onto the stent cage and don't have a sewing ring the valve itself is the same or slightly larger than a tradional valve that has a ring. One problem now is they don't make as many sizes of purcutaneous valves as regular ones, so if you need a size they don't make, you aren't a candidate. But if/when it is approved for more people the companiies will make more sizes.
From what I know about clinical trials, and why right now the only candidates for the Aortic trials, is when there is a surgery that has very good results with acceptable mortality/morbidty numbers, it is hard to get approval to start a trial to replace that. So in many cases, they get a trial approved by trying to help people that are not candidates for surgery because they are to ill to survive surgery and would die without out some kind of intervention, so the trial at least gives them some chance to live. Since the pulmonary trials were for people with a group of Complex Congenital Heart Defects who already had a certain size valve/conduit in place and there just aren't elderly people that fit that category there weren't the same restriction on who was a candidate for the trials, Also if they percutaneous valve doesn't work, in most cases they can do a OHS,.
Even when they are approved, from what I understand it will be quite a while before many places can do them . Besides the doctors and staff having to be trained. They center proably has to, or should, build a new hybrid suite to do them in.
