Description
Aortic stenosis affects as many as 1.5 million people in the United States. The progressive disease affects the aortic valve of the heart. While nearly 250,000 of these patients suffer from severe symptomatic aortic stenosis, about two-thirds of them undergo surgery to replace their ailing valve. Many patients are not treated because they are deemed inoperable for surgery, have not received a definitive diagnosis or they delay or decline the procedure for a variety of reasons. Those who do not receive an aortic valve replacement (AVR) have no effective, long-term treatment option to prevent or delay their disease progression. Without treatment, severe symptomatic aortic stenosis is life-threatening. Studies indicate that 50 percent of patients will not survive more than an average of two years after the onset of symptoms.
Figure 1
Figure 2
Fig. 1 depicts the leaflets of a healthy aortic heart valve which open wide to allow oxygen-rich blood to flow unobstructed in one direction. Blood flows through the valve into the aorta where it then flows out to the rest of the body.
Fig. 2 depicts the leaflets of a stenotic or calcified aortic valve unable to open wide, obstructing blood flow from the left ventricle into the aorta. The narrowed vlave allows less blood to flow through and as a result, less oxygen-rich blood is pumped out to the body, which may cause symptoms like severe shortness of breath.
A healthy aortic heart valve allows blood to flow freely while a stenotic valve restricts flow. Eventually, the extra work required to push the blood through the aortic valve weakens the heart’s muscles and increases the risk of heart failure.
Common Risk Factors
Genetic link – bicuspid aortic valve – In some cases, people are born with two leaflets, also known as flaps, instead of three. This results in a narrowed aortic valve or can lead to aortic stenosis later in life. Those with first-degree relatives – parent, sibling or child with a bicuspid aortic valve could be at a higher risk of also having this condition.
Age – Aortic stenosis occurs most often in those over the age of 75. In this case, it is most likely due to a buildup of calcium deposits in the heart valves.
History of rheumatic fever – Rheumatic fever can cause leaflets of your aortic valve to stiffen and fuse together, eventually resulting in aortic valve stenosis.
Additional risk factors may exist that can be tested by your physician.
Symptoms
- Severe shortness of breath leading to gasping – even at rest
- Chest pain or tightness
- Fainting
- Extreme fatigue
- Lightheadedness/dizziness
- Difficulty exercising
- Rapid or irregular heartbeat
Tests and Diagnosis:
To diagnose severe aortic stenosis, an examination is required that includes examining the heart and listening for a heart murmur. Typical tests include;
- Echocardiogram (ECG)
- Electrocardiogram (EKG)
- Chest X-ray
- Ultrasound
Treatment options
The gold standard for the treatment of severe aortic stenosis is surgical aortic valve replacement (AVR). This is an open-heart procedure during which the damaged “native” heart valve is removed and replaced with a prosthetic valve. This procedure is recommended for virtually all adult patients who do not have other serious medical conditions.
In some cases, patients are deemed inoperable for traditional open-heart AVR. In this case, a new procedure, transcatheter aortic valve replacement (TAVR) is now available as a treatment option. Approved by the Food and Drug Administration, Gulfcoast surgeons use the Edwards SAPIEN Transcatheter Heart Valve for the treatment of patients with severe symptomatic native aortic valve stenosis who have been determined by a cardiac surgeon to be inoperable for open aortic valve replacement. In order to be considered for the TAVR procedure, patients must not have other conditions that would preclude having the procedure. TAVR allows the diseased native heart valve to be replaced without open-heart surgery.
Back to Top
FAQ – These are the FAQs we have for Coronary Artery Disease – need input for this procedure.
What happens the day of surgery? Before the operation the patient meets the anesthesiologist and has special IV’s placed that are necessary for monitoring during the surgery. The patient is then brought to hybrid operating room, anesthetized, and the operation takes place. After surgery, the patient is brought to the open heart ICU. Once awake, the patient is taken off the ventilator (breathing machine) and is able to leave the ICU dependent on overall condition.
When can families visit? Families can visit in the ICU the day of surgery. Visiting hours for the remainder of the hospitalization are dictated further by hospital policy.
How long is the hospitalization and recovery? The hospitalization may be as little as three days, but is dependent on the patient’s overall condition. Beginning as early as the first postoperative day, patients may be out of bed and walking. Drains and monitors are gradually removed after which patients are discharged to home or rehabilitation as needed. A gradual return to normal activities occurs. In general, patients are instructed to walk each day, climb stairs as tolerated but not to lift heavy objects. Driving can begin usually after a week. Full recovery takes an average of about four to eight weeks.
Back to Top
References – Content for this page is adapted from the Edwards SAPIEN information kit.
1. Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363(17):1597-1607.
2. Bach D, Radeva J, Birnbaum H, et al. Prevalence, Referral Patterns, Testing, and Surgery in Aortic Valve Disease: Leaving Women and Elderly Patients Behind. J Heart Valve Disease. 2007:362-9.
3. Nkomo V, Gardin M, Sktelton T, et al. Burden of valvular heart diseases: a population-based study (part 2). Lancet: 2006:1005-11.
4. Iivanainen A, Lindroos M, Tilvis R, et al. Natural History of Aortic Valve Stenosis of Varying Severity in the Elderly. Am J Cardiol. 1996:97-101.
5. Aronow W, Ahn C, Kronzon I. Comparison of Echocardiographic Abnormalities in African-American, Hispanic, and White Men and Women Aged >60 Years. Am J Cardiol. 2001:1131-3.