At a crossroads: Surgical heart valve innovation slows as transcatheter treatments keep evolving
Surgical heart valve innovation is at a bit of a standstill, according to a new commentary written by two cardiac surgeons. Transcatheter technologies are evolving at a rapid rate, the duo added, making the lack of progress even more apparent.
The new analysis was published in full in the Journal of the American College of Cardiology.[1]
“Cardiac surgery is at a crossroads,” wrote first author Michael A. Borger, MD, PhD, and co-author Mateo Marin-Cuartas, two cardiac surgeons with Leipzig Heart Center in Germany. “Although our therapy is more invasive than transcatheter therapy, it is frequently more effective during longer follow-up periods due to the nuanced structural alterations that can be performed on a diseased heart under direct vision in a quiescent, bloodless field. The potential long-term benefits of our precise therapy need to be balanced against the increased invasiveness and (relatively short) recovery time, a minor consideration in patients with a long life expectancy.”
Borger and Marin-Cuartas pointed to new research on the Tria mitral valve, a polymer surgical heart valve from Utah-based Foldax, as an example of surgical heart valve innovation in action. The polymer valve was linked to positive data after one year and has already gained a commercial approval in India. However, the duo wrote, this success also “unveils a relative void in the area of surgical heart valve innovation over the last two decades.”
Why has surgical heart valve innovation slowed?
The commentary’s authors wrote that it “sometimes feels like the era of surgical heart valve innovation is over” after so many game-changing breakthroughs took place in the 1960s and 70s. In part, this is likely explained by the success of those early breakthroughs—surgical heart valves are now a “mature technology” and strong outcomes are expected, making it less of a priority to seek out new improvements.
Another potential barrier to innovation could be the surgeons themselves. The cardiac surgery community tends to be conservative when it comes to treatment strategies, avoiding risk and keeping things simple. This could be holding research back, the authors explained, because surgeons are so busy comparing effective procedures to one another that they may not spend enough time seeking even better alternatives.
“The palpable lack of interest in surgical research and investment has also contributed to some resentment within our community towards industry-sponsored trials comparing transcatheter heart valve therapy to surgery,” the authors added.
Perhaps the most obvious example of this trend is the large number of studies comparing transcatheter aortic valve replacement (TAVR) to surgical aortic valve replacement (SAVR). While TAVR gets the most attention, and patients certainly seem to prefer it over SAVR, surgical treatments remain a safe, effective option, especially for younger patients who may not want to undergo additional transcatheter treatments in another 10 to 20 years.
What needs to be done?
Looking ahead, the two authors wrote that cardiac surgery needs to do a better job organizing available data sources and developing new randomized controlled trials. In addition, they called for more investments in new research that underscores the long-term benefits of surgical heart procedures.
“If ongoing transcatheter heart valve trials in lower risk heart valve patients confirm the long-term benefits of surgery, industry may have a strong incentive to re-evaluate their relationship with our specialty,” the duo wrote. “Perhaps we can even approach the volume and success rates of the golden era of surgical heart valve innovation, a development that would be good for cardiac surgery and, more importantly, for our patients.”
Click here to read the full commentary.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.