Treatment for Aortic Stenosis

Aortic stenosis (AS) is the most common and most serious heart valve disease. AS is a narrowing of the aortic valve opening. The valve flaps may become stiff and can’t move easily or open fully. This makes it more difficult for the heart to push blood through the aortic valve to your body.

Let’s back up and look at what your heart valves do. Your heart beats 100,000 times a day and pumps blood through its four chambers. Four, one-way valves keep the flow going in one direction. Any damage to these valves could lead to a problem with the flow of blood to the body. A problem with blood flow can happen if a valve leaks or is narrowed (stenosed). Without treatment, AS can lead to heart failure or even sudden death.

Causes and Symptoms of Aortic Stenosis

Causes of AS include:

• Old age
• Cholesterol disorder
• Genetics
• Birth defects
• Rheumatic heart disease
• Bacterial infection of the valve

Symptoms include:

• Shortness of breath
• Dizziness/fainting
• Chest pain/tightness
• Feeling tired or fatigued
• Swollen legs
• Low blood pressure

Sometimes, a previously placed valve can get damaged over time and can leak or become narrowed.

Treatment Options for Severe Aortic Stenosis

Surgical Aortic Valve Replacement

Surgical aortic valve replacement (SAVR) was the only option for the treatment of aortic stenosis for many years. The procedure may be performed through an open surgery (opening the chest cavity) or a minimally invasive approach using a smaller incision. The patient’s breathing and circulation are transferred to a heart-lung machine during the surgery. The surgeon removes the diseased valve and implants an artificial valve.

Medical Management

Medical management is an option for patients who don’t wish to have the valve procedure or have too many other health problems making the valve replacement unsafe.

Medications help control symptoms without fixing the valve. This approach won’t prolong life but may limit symptoms.

Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement (TAVR) is a newer procedure that delivers a replacement valve in much the same way that a cardiac stent is implanted. TAVR is minimally invasive. It’s a well-established alternative to open heart surgery for patients of high, intermediate and even low surgical risk. This procedure doesn’t require stopping the heart or opening the chest cavity.

TAVR Procedure

Tests are done to see if TAVR is a good option for the patient. This revolutionary procedure involves placing a valve through a thin tube (catheter). The arteries in the body are like a system of roads that branch out from the heart. There are different “routes” to get to the heart to deliver the valve. These include:

• An artery at the top of the leg (femoral) – This is the most common approach.
• An artery near your collar bone (subclavian or axillary)

Once in place, the valve begins functioning immediately.

Choosing a Treatment for Aortic Stenosis

There are many things to consider when choosing a treatment. Will the treatment help? This is the big question. If symptoms are from severe AS, fixing the aortic valve may help patients feel better and live longer. If symptoms are from other health problems, fixing the aortic valve may not help someone feel better or live longer.

Ask questions. Patients should know what kind of results to expect with each treatment and should share any concerns with their provider.

You and your care team can make the choice together.

UMass Memorial Medical Center is the first hospital in Massachusetts to achieve certification for TAVR by the American College of Cardiology and boasts excellent results.