Aortic Stenosis is a condition most commonly caused by an accumulation of calcium that narrows the aortic valve and makes it more difficult for the oxygenated blood to leave the heart and travel to the rest of the body. Aortic stenosis affects about 2.5 million Americans over the age of 75. Other causes include a congenital heart defect such as bicuspid aortic valve or rheumatic heart disease from an untreated infection.
Many people with Aortic Stenosis, or AS, won’t experience any symptoms until the aortic valve becomes heavily calcified resulting in severely reduced amount of blood flow through the valve.
Symptoms of Aortic Stenosis
Symptoms that might come about with Aortic Stenosis include:
- Chest discomfort
- Trouble breathing or feeling short of breath, especially with activities
- Feeling dizzy or light-headed
- Swelling in legs and feet
- Difficulty sleeping or needing to sleep sitting upright
- Feeling tired and unable to do normal activities
If you have severe Aortic Stenosis and have symptoms, you will need a valve replacement. Half of those who fail to have the valve replaced die within two years; 80% within five years.
Cardiovascular surgeons have long been able to surgically replace the aortic valve. However, many patients can’t have surgery if they’re at an extreme risk for complications, so it's important to get routine check ups with your provider.
Is TAVR an Option for Treatment?
Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure to replace the aortic valve without opening the chest. In this procedure a wire is inserted into the groin (femoral) artery and passed through the patient’s narrowed aortic valve. The new valve is deployed, pushing the old valve out of the way and functions as a new valve immediately. This releases the obstruction, allowing oxygenated blood to flow through the body better.
In most cases, the procedure lasts 60 minutes and is performed under conscious sedation without general anesthesia. Most patients are discharged the following day and are usually back to normal activities within a week.
Safety and Benefits of TAVR
The initial clinical trials of TAVR began over a decade ago in patients who were too ill to be considered for surgery. These trials showed benefit at extending quality and survival in symptomatic patients with severe AS. Since that time, trials have been performed comparing TAVR to surgery in patients who are considered high risk, intermediate risk and low risk for traditional surgery. In each of these trials, TAVR was shown to be no worse, and sometimes even better, than surgery in regards to certain outcomes. After the FDA’s approval for low surgical risk patients in 2019, TAVR procedures exceeded all forms of surgery for the first time. Because of the minimally invasive aspect and quick recovery with TAVR, it soon became the standard of care for most patients with symptomatic Aortic Stenosis.
While TAVR has major benefits, there are risks involved, as there are for any heart procedure. The risks include death, stroke, bleeding, irregular heart rhythm, pacemaker and need for emergency surgery, but these risks are low.
TAVR is appealing for most patients, however it may not be the best treatment for everyone. Some people may have aortic valve anatomy that is not ideal for TAVR and traditional surgery could be a better long-term option for them.
If you have severe aortic valve stenosis, it is important to be evaluated by a structural heart team that includes a general cardiologist, an interventional cardiologist, and a cardiac surgeon. The valve team will review all the relevant medical information and discuss treatment options with you.
Reach out to the CHI Health Heart Institute for more information.