As more Americans approach their twilight years, a new, less invasive procedure for repairing faulty heart valves, called TAVR, offers patients a new lease on life. The only challenge is high costs limit its profitability.
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nterventional cardiologist Stanley J. Chetcuti, left, and cardiac surgeon G. Michael Deeb perform a minimally invasive heart valve replacement at the University of Michigan Frankel Cardiovascular Center in Ann Arbor.
Nearly five years ago, the U.S. Food and Drug Administration approved a new type of heart valve for patients with a progressive cardiac condition who were deemed too ill to undergo standard heart surgery. The decision opened the door to treatment for patients otherwise doomed to struggle with increasingly creaky aortic valves, the ones that control the flow of blood throughout the body.
But what is a lifesaver for these patients, and a welcome option for cardiologists who care for them, isn’t necessarily good news for the participating hospitals, at least fiscally. With a price tag of about $33,000, the valves take a huge bite from reimbursements that cover a team of surgeons, interventional cardiologists, and support staff, along with resources such as a hybrid operating room or a catheterization lab.
Transcatheter aortic valve replacement, or TAVR, is arguably the hottest innovation in cardiac care today. A handful of health systems in metro Detroit offer TAVR, including the Detroit Medical Center, Henry Ford Health System, the University of Michigan, Beaumont Health System, Oakwood Healthcare (now part of Beaumont), and more, with others likely to add the procedure in coming years.
“Everybody wants to be in the game, because if you’re not in the game your ability to market yourself as a cardiovascular center is pretty limited,” says Dr. G. Michael Deeb, the director of the multidisciplinary aortic clinic at the U-M Cardiovascular Center in Ann Arbor, and a leading TAVR researcher.
The procedure addresses aortic stenosis, a disease that comes with age. Like mechanical valves that stiffen as they accumulate deposits over time, so do heart valves.
TAVR allows physicians to snake a catheter through an artery at the groin up to the heart and place a crimped-up valve within the ailing aortic valve. The TAVR device then expands, pushing aside the failing valve. From there, it takes over the original valve’s function, opening and closing like healthy tissue.
As more people reach retirement, the potential TAVR patient population increases. According to one analysis, more than 91,000 Americans with aortic stenosis qualify for TAVR, and another 8,200 are entering the rolls annually. Today, Medicare will cover patients who are at very high risk of dying if they undergo surgical aortic valve replacement. Clinical trials currently underway may pave the way for intermediate-risk patients — those whose option now is to either have their chests cracked apart for open-heart surgery or forgo surgery and live with the condition.
“This procedure … will probably be one of the most common procedures performed because we have an extremely large aging population,” Deeb says. “Everybody wants a piece of the pie.”