Catheter-based heart valve therapy is gaining ground.

Prof. Dr. med. Jürg Grünenfelder

Prof. Dr. med. Jürg Grünenfelder

Catheter-based heart valve therapy is performed without opening the chest and using the heart-lung machine on the beating heart.

Many patients who have had heart valve operations describe the procedure as very stressful. The use of the heart-lung machine or the opening of the chest are perceived as particularly traumatic. In many cases, neither is necessary, explains Prof. Jürg Grünenfelder, MD, a specialist in cardiac surgery and director of HerzKlinik Hirslanden in Zurich, Switzerland.

"We are operating on more and more patients with a catheter-based method. Access is usually via the groin. For a long time, this method was only used when patients suffered from considerable secondary diseases or had already undergone heart valve surgery. But we have achieved very good results with this method in recent years and our patients recover much faster than with minimally invasive or open heart valve surgery".

Up to now, the catheter-based method has mainly been used for diseases of the aortic valves. Cardiac expert Grünenfelder believes that it will also be possible to use the method for the clinical treatment of mitral valves.

Cardiac arrest only for a few seconds

The great advantage of catheter-based heart valve surgery is that it can be performed on the beating heart, so to speak. The new heart valve is inserted into the inguinal artery folded up and pushed to the beating heart by a catheter, a thin plastic tube. The heart is "stopped" for only 10-15 seconds by the impulse of a pacemaker. During this short time, the new valve is unfolded by balloon. The old heart valve is not cut out as in other surgical methods, but pressed against the vessel wall by the new valve and remains in place. After stopping the pacemaker, the normal heartbeat is automatically resumed.

Short surgery, quick recovery

The catheter-based heart valve procedure takes only 45 minutes. Experienced surgeons and cardiologists can perform it in only 30 minutes, confirms Prof. Grünenfelder. The shorter the intervention, the less stress for the patient. In addition, the exchange of valves via catheter does not necessarily have to be performed under general anaesthesia. By comparison, a minimally invasive heart valve operation with access near the breastbone or in the intercostal space and use of the heart-lung machine takes 2 to 2 1/2 hours.

"The big advantage is that patients can leave the clinic after only a few days," says the heart specialist. "A rehabilitation stay is usually not necessary. Overall, if everything goes according to plan, the recovery takes about 4 weeks - with the minimally invasive 6-8 weeks and the open method at least two to three months".

Low risk

Measured by the mortality rate within the first 30 days after surgery, there is only a very low risk for both minimally invasive and catheter-based heart valve surgery. Younger patients without additional diseases are often operated on using the minimally invasive method. The mortality risk here is less than one percent. Although catheter-based heart valve surgery has so far often been used for older patients or for second operations, the mortality risk here is only 1 to 2 percent.

"These results will contribute to the fact that in future even more patients will be operated on using catheters", Prof. Grünenfelder confirms: "Provided that there are no anatomical difficulties, there is little reason why this gentle intervention should not benefit the majority of patients".

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