New Treatment Options for Aortic Valve Stenosis
The heart is like a motor that pumps blood to various organs. Heart valves are important to keep blood flowing in the right direction as it enters and leaves the heart. Valve-related problems disrupt blood flow and prevent oxygenated blood from being delivered efficiently to the body’s organs to keep them functioning. One of the four heart valves may be too tight, so much so that blood cannot easily pass through. A too-tight valve is medically known as stenosis, and it can occur in any of the heart’s four major valves.
The TAVI/TAVR (or trans-catheter aortic valve replacement procedure is a treatment for aortic valve stenosis, or a too-loose aortic valve, which causes valve insufficiency. Aortic valve stenosis (AS) is one of the most common heart valve problems and the most serious valve diseases affecting adults, and AS occurs in about 7 percent in individuals over age 65. AS is also the most common reason for valve replacement procedures.
Aortic stenosis is a significant narrowing of the aortic valve opening. Specifically, AS restricts the critical blood flow from the left ventricle to the aorta and may also affect the pressure in the left atrium. Primarily affecting older people, AS usually results in scarring and calcification in the valve flap, or cusp.
Age-related aortic stenosis usually begins after age 60, but often does not show symptoms until ages 70 or 80. Also, AS can occur in newborns and young children as a birth defect. Over time, the defective valve may become stiff and narrow because of calcium build-up.
Symptoms can vary widely, particularly depending on the age of person and stage of the disease. Unfortunately, many AS sufferers do not experience detectable symptoms until the amount of restricted blood flow becomes severely reduced, which can lead to heart failure. Symptoms of aortic stenosis may include:
- Shortness of breath or complete breathlessness
- Chest pain (angina), pressure or tightness
- Fainting or dizziness
- Palpitations or a feeling of heavy, pounding, or noticeable heartbeats
- Decline in regular activity and/or reduced ability complete normal activities
- Heart murmur
Treatment options for aortic stenosis have evolved dramatically over the past decade. Surgical aortic valve replacement (SAVR) was the gold standard for the treatment of severe AS for over 50 years. But nowadays, the procedure using minimally invasive transcatheter aortic valve replacement (TAVR) has recently become the most common method of aortic valve replacement for our patients, especially those patients at high surgical risk. Developments have made it possible for surgeons to offer TAVR to patients at intermediate surgical risk. And now TAVR continues to expand into “low-risk” patients as well through randomized clinical trials also being performed in Hamburg at the University Heart Center at UKE.
Minimalist Percutaneous Approach
In recent years, another procedure has had some notable success. The minimalist percutaneous approach differs from traditional TAVR because the patient undergoes “conscious sedation” and not general anesthesia, and is performed completely percutaneously – meaning through the skin, and not open chest. The main advantages of this approach include:
- reduced overall (physical/mental) stress on the patient,
- faster immediate recovery,
- shorter hospital stay (discharge within 24 to 48 hours)
- little to no surgical wound management
- shorter recovery time to resume routine activities
- decrease the risk of stroke during TAVR