July 25, 2017, Morristown, NJ – A new study published in the European Heart Journal outlines a different way for cardiologists to determine which patients with aortic stenosis (AS) – a narrowing of the aortic valve in the heart that keeps it from opening fully – are most likely to be alive one year after a heart valve replacement procedure. Philippe Genereux, MD, an interventional cardiologist and Co-Director of the Structural Heart Program at the Gagnon Cardiovascular Institute at Atlantic Health System’s Morristown Medical Center, served as the paper’s primary (lead) author.
Under current guidelines, cardiologists considering a heart valve replacement for patients with AS use cardiac imaging to assess the narrowing of the valve, valve function, co-morbidities (chronic conditions), and other risk factors as determined by a patient’s Society of Thoracic Surgeons (STS) risk calculator score. The new study suggests that classifying patients differently – with a stronger emphasis on the extent of cardiac damage before valve replacement – predicts which patients will survive one year later.
The study – Staging Classification of Aortic Stenosis based on the Extent of Cardiac Damage – is similar to the staging classification used with patients with cancer, where a lower stage indicates less disease, and showed that for each stage of cardiac damage, the risk of death increased by about 45 percent.
Stages were defined as:
- Stage 0 (no cardiac damage)
- Stage 1 (left ventricular damage)
- Stage 2 (left atrial and mitral valve damage)
- Stage 3 (pulmonary vasculature and tricuspid valve damage)
- Stage 4 (right ventricular valve damage)
1,661 patients from Edwards Lifesciences’ PARTNER (Placement of Aortic Transcatheter Valves) 2 trials were assessed and pooled into five staging (risk) categories based on the extent of heart damage as assessed by echocardiography before they underwent a valve replacement procedure. The extent of cardiac damage, more than the usual risk factors as measured by STS score and frailty, was independently associated with an increased risk of death after an aortic valve replacement.
After one year, 4.4 percent of patients in Stage 0 (2), 9.2 percent of patients in Stage 1 (19), 14.4 percent of patients in Stage 2 (116), 21.3 percent of patients in Stage 3 (85), and 24.5 percent of patients in Stage 4 (33) had expired.
“Cardiologists are constantly looking for direction in how to best choose and treat patients with aortic stenosis,” said Genereux. “While many times this means recommending a valve replacement, this study demonstrates that the extent and level of cardiac damage should be a critical deciding factor. We wanted to provide a simple and intuitive way to characterize the consequences of the disease and assess its impact on survival. With that information, thousands of patients undergoing valve replacement procedures each year could be better informed and more confident about their cardiologist’s decision.”
The landmark paper comes on the heels of Morristown Medical Center’s announcement that it was the first hospital in the world to randomize a patient to the EARLY TAVR (Evaluation of Transcatheter Aortic Valve Replacement Compared to SurveilLance for Patients With AsYmptomatic Severe Aortic Stenosis) trial, for which Genereux serves as the trial’s principal (lead) investigator. The EARLY TAVR trial is sponsored by Edwards Lifesciences.
The paper is available on the European Heart Journal website and can be found through its doi number: 10.1093/eurheartj/ehx381.
About Aortic Stenosis (AS) and Transcatheter Aortic Valve Replacement (TAVR)
Aortic stenosis (AS), one of the most common and serious valve diseases, is a narrowing of the aortic valve opening, restricting blood flow from the left ventricle of the heart to the aorta. Symptoms of AS include shortness of breath, chest pain, pressure or tightness, palpitations, fainting and decreased physical activity. For patients considered intermediate or high risk for surgical aortic valve replacement (TAVR) – a procedure where the heart’s aortic valve is replaced through a catheter in the groin as compared to open-heart surgery, is an FDA-approved, minimally invasive procedure to replace an aortic valve that has narrowed and fails to properly open.
About the Gagnon Cardiovascular Institute at Morristown Medical Center
The Gagnon Cardiovascular Institute at Morristown Medical Center, part of Atlantic Health System, was the first hospital in New Jersey to offer TAVR, and treats more valve patients than any other hospital in New Jersey.
Learn more about our current trials for patients with aortic stenosis, heart failure or cardiomyopathy, or call the Valve Center at Morristown Medical Center at 973-971-7001.
About Atlantic Health System
Atlantic Health System, headquartered in Morristown, New Jersey, is a leading non-profit, clinically integrated health care system comprised of Atlantic Medical Group with more than 900 physicians and multispecialty care providers, medical centers, rehabilitation and urgent care. Atlantic Medical Group had more than 1.2 million patient visits in 2016. Atlantic Health System locations include Morristown Medical Center in Morristown, NJ; Overlook Medical Center in Summit, NJ; Newton Medical Center in Newton, NJ; Chilton Medical Center in Pompton Plains, NJ; Hackettstown Medical Center in Hackettstown, NJ; and Goryeb Children’s Hospital in Morristown, NJ, as well as Atlantic Rehabilitation Institute, and Atlantic Home Care and Hospice. It also includes its subsidiary, Atlantic Ambulance Corporation. Atlantic Health System comprises 1,747 licensed beds, nearly 16,000 employees and more than 3,700 physicians. Atlantic Health System has a medical school affiliation with the Sidney Kimmel Medical College at Thomas Jefferson University; is part of Atlantic Accountable Care Organization, one of the largest ACOs in the nation, and is a member of AllSpire Health Partners.