Aortic Valve Disease

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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. 

 

Treatment Options

Until recently, open-heart surgery had been the standard treatment for significant aortic valve stenosis.  Open heart surgery is a safe and effective treatment for most patients; however, it involves opening the breastbone (sternotomy), and requires a hospital stay of, on average, 5-8 days, with full recovery at 2 months.   

A minimally invasive technique, called Transcatheter Aortic Valve Replacement (TAVR) had been reserved only for patients who were too sick or too old to undergo a surgical replacement.  However, in the spring of 2019, TAVR was FDA approved for patients with a low surgical risk, in addition to intermediate and high risk patients.  This allows TAVR to be offered to the majority of patients with aortic stenosis, with a much shorter recovery time and lower procedural risk than open heart surgery.

During a TAVR procedure, wires are placed into the femoral artery (large artery in the groin area) and the TAVR valve is inserted into the artery, to the heart with a catheter guided by a special type of x-ray. The 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.

Patients who have a TAVR procedure can expect to be in the hospital for 1 to 3 days and can resume normal activities in as little as 1 week. 

 

TAVR

TAVR Image courtesy of Edwards Lifesciences

 

 

Valve-in-Valve Procedure Offers Minimally Invasive Option for Replacing Bioprosthetic Valves

Just as a natural heart valve can degenerate and fail over time, so too can a surgically placed bioprosthetic (tissue) heart valve, requiring the need for a replacement valve 10-15 years post-surgery.

The standard treatment for a failed heart valve has been surgery, however repeat cardiac surgery carries significant risk, especially for older patients.

Transcatheter aortic valve replacement (TAVR) technology offers a minimally invasive procedure to patients who previously underwent open-heart surgery for a bioprosthetic valve. This option is especially beneficial for patients at high-risk for surgery as it allows them to recover in less time — typically one week versus three months.
 
Using the less invasive “valve-in-valve” procedure, a new transcatheter valve is placed tightly into the opening of the failed surgical valve, pushing the old valve leaflets aside.

Be sure to talk to your doctor to find out if a minimally invasive TAVR procedure is right for you as you near the lifespan of your bioprosthetic valve.

There are risks associated with both TAVR and surgery.  Our physicians will outline the risks during your evaluation appointment.

 

Click here for information regarding clinical trials relevant to TAVR.