Transcatheter Aortic Valve Replacement:
Changing the Face of Treatment for Patients with Aortic Stenosis
What is Aortic Stenosis?
Aortic stenosis is a progressive disease that occurs with a narrowing of
the patient’s aortic valve opening due to a buildup of calcium deposits
on the valve leaflets. When the valve fails to open fully, the valve opening
narrows thereby obstructing blood flow out of the heart. Over time, the
leaflets become stiff, reducing their ability to fully open and close.
When the leaflets don't fully open, a person's heart must work
harder to push blood through the aortic valve to the rest of the body.
Eventually, the heart gets weaker, increasing the risk of heart failure.
Aortic stenosis primarily happens over time as we age but can also be caused
by a birth defect, previous chest radiation, or rheumatic fever. The prevalence
of aortic stenosis increases with age. It is estimated that approximately
2.5 million people, or 12.4% of the population, in the United States over
the age of 75 suffer from aortic stenosis.
Overview of Aortic Stenosis
Human heart valves are remarkable structures. Normal heart valves have
two or three flaps of tissue called leaflets. These tissue-paper thin
membranes attached to the heart wall constantly open and close to regulate
blood flow (making the sound of a heartbeat).
In elderly patients, aortic stenosis is sometimes caused by the buildup
of calcium (mineral deposits) on the aortic valve’s leaflets. Over
time, the leaflets become stiff, reducing their ability to fully open
and close. When the leaflets don’t fully open, a person’s
heart must work harder to push blood through the aortic valve to the rest
of the body. Eventually, the heart gets weaker, increasing the risk of
heart failure (when the heart cannot supply enough blood to the body).
Severe Aortic Stenosis
Aortic stenosis is a progressive disease which means it gets worse over
time. It’s typically measured as mild, moderate, or severe aortic
stenosis. As a result of the reduced blood flow, the body does not get
the oxygen it needs, which may cause symptoms. If a patient has been diagnosed
with severe aortic stenosis and is experiencing symptoms, it can be life-threatening
and may progress rapidly.
However, it’s important to know that heart valve disease may occur
with no outward symptoms. Many patients initially appear asymptomatic,
but on closer examination, up to 32% exhibit symptoms. The symptoms listed
below are typically associated with severe aortic stenosis but are commonly
misunderstood by patients as “normal” signs of aging.
Symptoms of Severe Aortic Stenosis
You may notice symptoms like:
• Shortness of breath
• Fatigue/significant decline in energy levels
• Lightheadedness, feeling dizzy
• Fainting, passing out
• Chest pain
Major Risk Factors
Factors associated with aortic valve disease include the following:
• Increasing age
• High blood pressure
• High cholesterol
• Smoking
Severe aortic stenosis is life-threatening, and treatment for this condition
is critical. Patients who have developed symptoms from severe aortic stenosis
have about a 50% chance of living at 2 years and 20% at 5 years without
aortic valve replacement.
Diagnosis
In addition to a physical exam, severe aortic stenosis is diagnosed in
several ways, the most common being an echocardiogram and/or cardiac catheterization
(angiography). As part of your evaluation for valve replacement, you can
also get an electrocardiogram (EKG), chest X-ray, or CT Scan.
What is Transcatheter Aortic Valve Replacement (TAVR)?
TAVR is a less invasive procedure than open-heart surgery which allows
a new valve to be inserted within the native, diseased aortic valve. The
TAVR procedure can be performed using one of many approaches, the most
common being the transfemoral approach (through an artery in your groin).
The BHS Heart Team will decide which approach is best, based on your medical
condition and other factors.
To find out if you are a candidate for TAVR, make an appointment with the
BHS Valve Clinic by calling 724-284-4026.
Source: Edwards Lifesciences Corporation