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![\"Top](\"https:\/\/www.heart-valve-surgery.com\/Images\/sapien-heart-valve-replacement-edwards-1.jpg\")
\nEdwards SAPIEN Aortic Valve Replacement<\/p>\n
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I wanted to provide Anita an expert opinion so I contacted Dr. Craig Smith, the principal investigator for the SAPIEN clinical trials.<\/p>\n
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<\/p>\n In response to Anita’s question, Dr. Smith offered several insights. First, he addressed the available sizes and constraints of the SAPIEN aortic valve replacement:<\/p>\n <\/p>\n The SAPIEN valve comes in two sizes (23 and 26 mm), with a 29 mm size that is just beginning to be used in the US.\u00a0 At least 80% of patients are treatable with the 23 or 26 valves.\u00a0 Relatively few “normal” valves are smaller than 18 mm or larger than 26 mm, as they are measured by echocardiography or CT scan.\u00a0 A “big” man doesn’t necessarily have a “big” valve, especially if “big” refers to weight more than height.\u00a0\u00a0 There are size limitations for the valve delivery system based on the size of the major blood vessels in the lower body, but the transapical delivery alternative allows most patients to be treated regardless.<\/p><\/blockquote>\n <\/p>\n Dr. Smith then addresses the utility of the SAPIEN relative to other traditional, surgical approaches and devices:<\/p>\n <\/p>\n If this man is in good general health for an 86-year-old, the SAPIEN valve might not be a relevant consideration, and he should have conventional open-heart aortic valve replacement (AVR).\u00a0 This will be true of one-third to one-half of patients over 80.\u00a0 If his surgical risk is moderately elevated by issues in addition to age, he would be eligible for the PARTNER II Trial of the SAPIEN valve, in which he would be randomized to receive either the SAPIEN valve or conventional aortic valve replacement<\/a> (50% chance of receiving SAPIEN).\u00a0 If his surgical risk is extreme, as determined by one or more surgical opinions, he can receive the SAPIEN valve without being part of a trial and without being randomized.\u00a0 These options can be sorted out at any center participating in the SAPIEN trials.\u00a0 Similar trials of the CoreValve device<\/a> (different design) are ongoing in earlier stages, and I’m sure any CoreValve center would be delighted to evaluate him as well.<\/p><\/blockquote>\n <\/p>\n![\"Surgeon](\"https:\/\/www.heart-valve-surgery.com\/profileImages\/40.jpg\")
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\nDr. Craig Smith<\/p>\n