About the Aortic Valve
The aortic valve is located on the left side of the heart and serves as the gateway between the left ventricle–the largest chamber of the heart–and the aorta–the largest artery in the body. The aortic valve is normally comprised of three leaflets (flaps) which open and close to regulate the supply of blood to the body and prevent blood from flowing back into the heart.
What is Aortic Valve Disease?
The two most common conditions affecting the aortic valve's ability to regulate blood flow are:
Aortic stenosis: a narrowing of the orifice (opening) of the valve most often caused by age-related degenerative changes, calcium deposits, or a bicuspid valve (two leaflets instead of three). The constricted valve limits blood from flowing out of the heart and into the rest of the body.
Aortic regurgitation or insufficiency: a condition where the valve does not close normally. This allows blood to leak back or “regurgitate” into the heart rather than flowing forward and supplying blood to the organs.
The heart of those who suffer from aortic valve disease has to work harder to pump blood to the body. Eventually this will cause a weakening of the heart muscle increasing the risk of irreversible damage and heart failure. Someone with aortic valve disease will experience:
- Shortness of breath, particularly during exertion
- Chest pain (angina)
- Heart palpitations
- Weakness and tiredness
- Dizziness and fainting
These symptoms will cause a decrease in one's quality of life and can be life-threatening if left untreated. In fact about half of those with severe aortic stenosis who are symptomatic, on average, will live no longer than two-years following diagnosis.
If it is decided that your heart valve disease requires treatment, our clinical team will review treatment options with you. At this time, drug therapy does not exist to treat aortic valve disease. There are some medicines that can improve how you feel, however only in the short-term.
The gold standard for treating significant aortic valve disease is open-heart surgery, a safe and highly effective treatment for most patients. The aortic valve is repaired or replaced with a bioprosthetic (tissue) or mechanical valve. The surgeon makes an incision down the center of the sternum (breastbone) to access the heart. The procedure may require a sternotomy (opening of the chest bone) or may be performed through a lesser invasive approach using a small incision to access the aortic valve. Patients are placed on a heart-lung bypass machine which temporarily takes over the function of the heart and lungs, maintaining blood circulation during portions of the procedure. Mortality for open-heart surgery at our institution is consistently well below the national average for academic medical centers, and the rate of all major complications is under two percent.
Evidence suggests that those who are motivated to recover tend to recover more quickly and spend fewer days in the hospital. This, of course, varies depending on the severity of your medical condition.
On average, those who have open-heart surgery can expect to remain in the hospital for 5 to 10 days post-procedure. The first 48 hours are spent on an intensive care unit (ICU) followed by a step down cardiac care unit (intermediate care) or a regular bed for the remainder of your hospital stay.
Learn more about aortic valve surgery at the Columbia Aortic Center.
Approximately 300,000 people in the United States have aortic stenosis, and about one third of these patients are too sick or too old to undergo surgical replacement. A minimally invasive technique, called Transcatheter Aortic Valve Replacement (TAVR), is available for these patients. A prosthetic valve is delivered to the heart with a catheter guided by a special type of x-ray. The prosthetic valve is carefully positioned inside the patient's own valve and expanded. The diseased leaflets are pushed aside and replaced with the new valve which will immediately begin to function.
The replacement valve may be advanced to the heart through either the femoral artery or transapically, a minimally invasive technique where a small incision is made under the left chest and the valve is advanced from just below the heart, designed for people whose femoral vessels are not appropriate for transfemoral access. The Transaortic Approach involves direct access to the aorta via a mini-sternotomy directly above the breast bone. This approach is appropriate for patients who have inaccessible femoral arteries and are unsuitable for the transapical approach, often because of poor respiratory function. Our team of physicians will evaluate your medical records and images to determine the best approach for you.
Patients who have a TAVR procedure can expect their length of stay, on average, to be:
- 3 to 5 days for transfemoral access.
- 4 to 7 days for transaortic approach.
- 5 to 10 days for transapical procedure.
Those who have a transapical or transaortic TAVR will be in the ICU for approximately 48 hours; those who have a transfemoral TAVR can expect to be in the ICU for approximately 24 hours.
There are risks associated with both TAVR and surgery. Our physicians will outline the risks during your evaluation appointment.
View an animation of the TAVR procedure