By Marti Webb Slay
When Hassan Alkhawam, MD, interventional and structural cardiologist at UAB St. Vincent’s, had a patient needing a new aortic valve, he recognized the patient would be best served with a new valve on the market. Abbott’s Navitor™ Vision valve is the latest addition to the Navitor transcatheter aortic valve implantation (TAVI) system, a minimally invasive therapy to treat severe aortic stenosis. The valve incorporates three radiopaque markers designed to help physicians deploy it more precisely at the intended depth. The FDA has approved the valve for patients at high or extreme surgical risk.
“Up to 15 years ago, the only treatment for severe aortic stenosis was open heart surgery,” Alkhawam said. “Now we have more options with transcatheter aortic replacement, and in the last 15 years it has been advancing.”
“This newest valve has several benefits due to advanced engineering. It offers better sealing so we don’t have leaking around the valve when there is a lot of calcium, and in the future if we need to access the coronary again, we can do that easily and put in stents if needed without any difficulty.
“Deploying the valve is more visible in patients with peripheral vascular disease compared to the other valves as well. This valve has three radiopaque markers so when we are deploying the valve, we can see under the x-ray where we are deploying it, so we are able to install the valve in the appropriate position to achieve excellent hemodynamic results. That’s very advanced technology.”
Alkhawam was one member of a team which included Mustafa Ahmed MD, structural heart director and interventional/structural cardiologist, and Parvez Sultan, MD, cardiothoracic surgeon. They have now successfully completed two surgeries with the new valve.
The first patient had a lot of calcium in his aortic valve, and since the Navitor valve doesn’t push the calcium, Alkhawam felt it would be a better option over the two older valves on the market. Also, since the surgeons would typically expect high risk of paravalvular leakage in patients with a lot of calcium, he wanted to use the Navitor valve. It worked.
“We did not have any leak at all,” he said. “We had amazing results for the first case. Also the patient had a lot of blockages in his heart, so he might need a cardiac catheterization in future. With this valve, we will be able to access his coronary in the future without a problem.”
The minimally invasive TAVI procedure typically requires an overnight stay in the hospital. “We go through the femoral artery to deploy the valve. Usually it takes around 30 to 35 minutes on average, and the patients stay overnight. Next day, if everything is good, they go home,” Alkhawam said.
Patients can perform most usual daily activities once they return home but may not drive or lift more than 10 pounds for a week following surgery.
Since the valve is new there’s not a great deal of long-term data, but Alkhawam said they expect the valves to last at least eight years, if not longer. “And after eight years, if they need something else, most likely, we can put another valve inside the old valve. We don’t have to open the chest,” he said, “but that’s a case-by-case decision.”
Alkhawam encourages referring physicians to understand the benefits of the Navitor valve and to know the team at St. Vincent’s has successfully completed Navitor TAVI on patients who may otherwise not have been candidates for valve replacement.
“If they have severe aortic stenosis, they are considered high risk, and they have a lot of calcium in the aortic valve with a risk for paravalvular leak, or if there is a chance they will need to access coronary in future, this valve is a great choice,” he said. “We have every technology in the United States available right now in Birmingham.”