Alastair Philips, MD, FACC
Co-Chair, the American College of Cardiology Surgeon’s Council
The aortic valve is one of four valves in the heart; it allows blood to flow into the aorta, which is the main artery that carries blood out of the heart and into the rest of your body. Aortic stenosis is when the valve does not fully open, making it difficult for blood to flow freely, making the heart work harder and ultimately leading to heart failure.
Limited options
Acquired aortic valve stenosis usually occurs later in life. It has many symptoms, including fainting, chest pain, shortness of breath, weakness and being overly tired; however, symptoms can take a long time to develop. If aortic valve stenosis becomes too severe, the best treatment can be a valve replacement. In the past, this was done via surgical aortic valve replacement, where the chest is opened and the diseased valve is replaced with a new valve.
Many patients are not good candidates for open heart surgery due to age or other medical conditions, and prior to TAVR the only option outside of surgery for severe cases of aortic stenosis was medications, which only served to limit symptoms, or balloon valvuloplasty, which had limited success and only helped temporarily.
Exciting developments
In 2011, the Food and Drug Administration approved TAVR as a less invasive way to replace a valve. A multidisciplinary team called the heart team evaluates all patients requiring aortic valve replacement to determine the best approach for each patient.
With TAVR, a cardiologist and cardiac surgeon usually work together to place a long flexible tube, called a catheter, to thread a replacement valve into the heart from a puncture usually in an artery near the patient’s groin. Other approaches are tailored to the needs of the patient. With TAVR, patients are usually in the hospital for only two to three days and recovery time is one to two weeks.
Ongoing success
Since its approval, more than 50,000 patients have undergone TAVR in the United States, and nearly half of all hospitals performing standard open heart surgery now also offer TAVR. It is expected that the number of TAVR cases performed will exceed standard surgical aortic replacements this year. While TAVR is not without risks, some of the patients with the most severe forms of aortic stenosis now have another option to replace their diseased valve and help them live longer.
Not everyone is a candidate for TAVR, so patients should talk with their doctors about what treatment options might be right for them. The goal with treating aortic stenosis is to improve symptoms and prolong life; your doctor can tell you if TAVR is the right way to accomplish that goal.