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Newer heart valves help more people avoid surgery

The operation of certain heart valves could soon be a thing of the past. Recent studies indicate that it is okay and that it is better to insert a new valve through a tube into an artery instead.

The results are expected to rapidly transform the treatment of a problem affecting millions of people – a stiff or narrowed aortic valve that does not allow the blood to not run as it should. Until recently, severe cases had to be repaired with a heart-lung machine, while surgeons cut out the old flap and sew in a new one.

A decade ago, expandable aortic valves were developed that can be passed to the heart by placing a catheter in a blood vessel and in the old valve. However, they are only used in people who are at high or medium risk of dying from surgery. In the new studies, these valves were tested in people with low-risk surgery, as is the case with most patients, and found them to be good or superior to the surgical procedure.

"This is our last limit" to make these devices a standard. said dr. Joseph Cleveland, a University of Colorado heart surgeon with no role in studies or affiliations with the companies that sponsored them. "It's a great thing" that patients can avoid a major surgery.

The findings were published Saturday by the New England Journal of Medicine and were to be discussed at a New Orleans American College of Cardiology conference Sunday

In one study, about 1

,000 patients received standard surgery or an expandable Edwards Lifesciences valve , After one year, 15 percent of the surgical group and 8.5 percent of the others had died, had a stroke, or had to be hospitalized again.

In the other study, 1,400 patients received surgery or an expandable Medtronic valve. Based on partial results, the researchers estimated that after two years 6.7 percent of the surgical group and 5.3 percent of the others had died or had suffered a disabling stroke.

In both studies, certain problems were more common, including severe bleeding and the development of a fluttering heartbeat called atrial fibrillation. In the Medtronic study, 17 percent of the recipients of expandable valves later required a pacemaker compared to 6 percent of the patients who underwent surgery.

Earlier research suggests that the total cost is lower with expandable flaps that cost about $ 30,000 compared to $ 5,000 Cleveland, who is also a spokesperson for the College of Cardiology, said that it is much shorter Require hospitalization and cause fewer complications.

In the United States, the operations to replace aortic valves have fallen. It is expected that only about 25,000 will be done this year, and Cleveland expects to see it halved next year and halved again in 2021.

He and other physicians say the expandable valves still need a longer study to see if they also hold as surgical. Catheter-based approaches to problems with some other heart valves, such as the mitral valve, have also been developed or are under test.


Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP. 19659002] ___

The Associated Press's Department of Health and Science is supported by the Howard Hughes Medical Institute's Department of Scientific Education. The AP is solely responsible for all content.

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