The Heart Valve Center at NewYork-Presbyterian/Queens in partnership with NewYork-Presbyterian / Weill Cornell is dedicated to developing and evaluating new and less-invasive techniques for repairing and replacing damaged mitral, aortic, and pulmonary valves. The Center's team of collaborative experts across the NYP Network has played a leading role in clinical trials assessing the latest percutaneous valve replacement approaches, giving it greater experience than most centers in these emerging new techniques.
One of the most promising procedures for select patients with severe symptomatic aortic stenosis (narrowing of the aortic valve opening) is Transcatheter Aortic Valve Replacement (TAVR). This most common form of valvular heart disease affects up to 1.5 million people in the United States. As we age, our heart valves become stiff or weak and if this becomes severe enough, it will reduce the valve’s ability to open and close completely. Thus, less oxygen-rich blood is pumped out to the body and may cause such symptoms as shortness of breath, fainting, heart palpitation.
TAVR allows doctors to implant a device into a heart valve without open surgery. TAVR is an FDA approved treatment and is covered by Medicare and most major insurances. This transformative technique has made valve replacement possible for many patients who cannot tolerate conventional heart surgery, and who otherwise, would not have had any other treatment options.
Our physicians collaborate with a robust team of clinical specialists, including an experienced team of Physician Assistants, Clinical Coordinators, and Research Coordinators, who compassionately attend to all patient needs. Our program's success has been built upon the commitment of the heart team across the continuum of patient care. Together, the team assesses each patient using state-of-the-art diagnostic tools and recommends appropriate treatment solutions, including interventional and surgical options and medical therapy based on what is in the best interest of the patient. We are committed to comprehensive communication amongst our team, with the patient, with family members, and with referring physicians to ensure that everyone stays informed and involved in the patient's care.
Aortic Valve Treatment
If it is decided that your heart valve disease requires treatment, our clinical team will review treatment options with you. At this time, drug therapy does not exist to treat aortic valve disease. There are some medicines that can improve how you feel, however only in the short-term.
The gold standard for treating significant aortic valve disease is open-heart surgery, a safe and highly effective treatment for most patients. The aortic valve is repaired or replaced with a bioprosthetic (tissue) or mechanical valve. The surgeon makes an incision down the center of the sternum (breastbone) to access the heart. The procedure may require a sternotomy (opening of the chest bone) or may be performed through a lesser invasive approach using a small incision to access the aortic valve. Patients are placed on a heart-lung bypass machine which temporarily takes over the function of the heart and lungs, maintaining blood circulation during portions of the procedure. Mortality for open-heart surgery at our institution is consistently well below the national average for academic medical centers, and the rate of all major complications is under two percent.
Approximately 300,000 people in the United States have aortic stenosis, and about one third of these patients are too sick or too old to undergo surgical replacement. A minimally invasive technique, called Transcatheter Aortic Valve Replacement (TAVR), is available for these patients. A prosthetic valve is delivered to the heart with a catheter guided by a special type of x-ray. The prosthetic valve is carefully positioned inside the patient's own valve and expanded. The diseased leaflets are pushed aside and replaced with the new valve which will immediately begin to function.
The replacement valve may be advanced to the heart through either the femoral artery or transapically, a minimally invasive technique where a small incision is made under the left chest and the valve is advanced from just below the heart, designed for people whose femoral vessels are not appropriate for transfemoral access. The Transaortic Approach involves direct access to the aorta via a mini-sternotomy directly above the breast bone. This approach is appropriate for patients who have inaccessible femoral arteries and are unsuitable for the transapical approach, often because of poor respiratory function. Our team of physicians will evaluate your medical records and images to determine the best approach for you.
Mitral Valve Treatment
If the mitral valve disease is mild, medicine will be prescribed to treat the symptoms. If the disease is more severe, the current preferred treatment is a surgical repair of the patient's valve. The surgeon accesses the heart through a sternotomy (opening of the chest bone) and excises or repositions the diseased valve leaflets. In instances where the valve is severely diseased, a surgeon will perform a valve replacement using a mechanical or bioprosthetic valve. For some patients, a minimally invasive surgical option is available where a mini or partial sternotomy is performed involving a smaller incision on the chest. The mitral valve is accessed between the ribs, therefore not requiring the breastbone to be spread. The advantage to surgery includes an improved quality of life and expanded life expectancy, as the flow to the heart becomes regulated.
MitraClip, catheter-based treatment, is available for patients with significant symptomatic degenerative mitral regurgitation and are too high risk for surgery. In this procedure, a metal clip is advanced on a catheter delivery system, most often through the femoral vein in the groin, and guided by a special type of x-ray into the mitral valve. The MitraClip device then clips the leaflets of the valve together to reduce the amount of blood that flows back into the left atrium.