A life-saving Cardiology procedure has been such a phenomenal success that cardiologists now find themselves trapped in a cage - literally.
Austin Health interventional cardiologist, Dr. Matias Yudi, was published last month in the world's top Cardiology journal, the Journal of the American College of Cardiology, as lead author of one of the journal's ‘state-of-the-art reviews'. Dr. Yudi and co-authors looked into the issues following a procedure called transcatheter aortic valve replacement, or TAVR.
TAVR has been used with great success to treat aortic stenosis, a disease that causes people's aortic valve to narrow, limiting the amount of blood that can flow through it. It involves a metal mesh replacement valve deployed over the patient's own aortic valve to hold it open.
Dr. Yudi says that is has been so successful as a treatment that is being used with increasing frequency, including in patients who are younger, healthier - and more likely to live long enough to need other procedures in the Cardiac Cath Lab.
"The problem is that the replacement valve becomes like a cage that blocks access to the coronary arteries. It makes it hard to get a catheter in," says Dr. Yudi.
"Now that TAVR is generally used in younger people, there's a greater chance that they will go on to develop coronary artery disease in the future - and fixing it will be more difficult if there's effectively a cage around the artery," he says.
"There have been a couple of small reports from around the world where cardiologists have had trouble getting a stent in, and there have been complications," he says.
As part of their review, Dr. Yudi and his co-authors also discuss solutions to the problem. They have developed an algorithm to guide cardiologists to which catheter to use in each of the situations they are likely to encounter, but also make a suggestion on how cardiologists performing TAVR can orient the replacement valve as it's put in, in a way that makes it less likely that it interferes with access to the coronary arteries in future procedures.
"It's the first time a review of the problems surrounding TAVR has ever been published that incorporates both a comprehensive account of the technical problems, and provides guidance to practicing cardiologists," Dr. Yudi says.
As a result of this work, Dr. Yudi has now been invited to work with Medtronic in the United States to help develop a catheter that will solve some of the issues raised in the review.