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Aortic stenosis is a cardiac condition where the aortic valve of the heart narrows and calcifies, preventing it from fully opening. This obstructs blood flow from the heart to other parts of the body and makes the heart work much harder. The condition occurs most often in elderly individuals – up to 10% of those over the age of 70 will develop it. Without surgical intervention, the heart of a patient suffering from aortic stenosis can fail. Below, we’ll explore the symptoms of aortic stenosis and evaluate the traditional and new treatment options.
The symptoms of aortic stenosis include shortness of breath with exertion and severe fatigue, because blood can’t pump to the body adequately. These are the most common symptoms. Other symptoms can include lightheadedness, fainting from lack of blood supply to the brain, and, in some cases, chest pain. Once a person develops symptoms for aortic stenosis, a poor prognosis is likely without a valve replacement.
The traditional treatment for aortic stenosis is a valve replacement, which involves an open heart surgery and the replacement of the damaged valve with either a mechanical valve or a tissue valve, from an animal such as a cow or pig. While this is usually a successful solution to aortic stenosis, it requires a week to ten days in the hospital and a long recovery time. Elderly patients with other medical conditions can often be considered high risk for open heart surgery, so modern medicine has worked on developing other solutions.
Transcatheter Aortic Valve Replacement (TAVR), FDA approved in November of 2011, is a minimally invasive procedure that is offered for patients who face higher risks in open-heart surgery. Unlike invasive open-heart procedures where bad valves are fully replaced, TAVR repairs the damaged valve by placing a new valve within the old valve. The new valve is inserted on a catheter, through a large femoral artery in the groin. A stent holds the valve insert in place, and the new valve starts working immediately.
TAVR differs from other procedures in that it is far less invasive than open-heart surgery. Open-heart surgery involves general anesthesia, something that can be dangerous for people with other medical conditions. TAVR requires no medical incision, so the procedure can be done without general anesthesia.
In a partner trial, two patients at high risk were compared. Patients with high risk in regards to surgery, or those ineligible for open-heart surgery because of advanced age or another medical condition, did much better with the TAVR. The trial also compared the two procedures and there was a 20% increase in survival over the first year in patients who received the TAVR procedure, as opposed to the traditional valve replacement.
TAVR is currently approved for high risk patients, which can include people in their 80’s, and people with severe diseases like heart failure and lung disease. Younger patients can tolerate the anesthesia and recovery time required in open heart surgery, though there is a trial in place to try to get TAVR approved for medium-risk patients. As the procedure develops, the medical community and FDA may move toward TAVR for many different aortic stenosis patients.
In cases where no other conditions exist, many patients who receive the TAVR procedure are back on their feet in the matter of several days. The symptoms of aortic stenosis are so limiting to a patient’s quality of life. TAVR can help patients who once couldn’t walk across the room without getting winded get out and enjoy their life.
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Published June 14, 2019