Patients with aortic stenosis can do well over many years without symptoms or limitations at rest or when active. At some point, however, the aortic valve obstruction will overwhelm the heart’s pumping. This is usually when the aortic stenosis has advanced from mild or moderate to severe. If you have severe aortic stenosis, you may feel:
- More tired and exhausted
- Be short of breath with activities
- Develop chest discomfort with activities
- Lightheaded or even pass out
“Watchful observation” is recommended as long as patients have no symptoms. Once symptoms are present, replacing the valve may be considered. The valve can be replaced either through surgery or using a less invasive procedure called transcatheter aortic valve replacement (TAVR). Both approaches reduce symptoms and help patients live longer. At present, no medical therapy can “unclog” an obstructed aortic valve.
During a surgical aortic valve replacement (SAVR), you would be put under general anesthesia, and you would be placed on a ventilator while on a heart-lung bypass machine. A surgeon would then cut open your breastbone (called a sternotomy) to get to the heart. In some patients, less invasive approaches can be used. The aortic stenosis valve is cut out, and replaced by the new valve. Recovery in the hospital usually takes about five days.
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More recently, transcatheter aortic valve replacement has emerged as an alternative approach to treat certain patients with aortic stenosis. TAVR does not require sternotomy and heart-lung bypass machine. The replacement valve is usually inserted using a catheter into an artery in the leg, then threaded through arteries to the heart. Once correctly positioned within the diseased aortic valve, the folded TAVR valve is opened up with a balloon and the old valve pushed to the side. Recovery in the hospital is usually about one to two days.
Overall, TAVR has been an exciting development in treating patients with aortic stenosis, but there are limitations:
- There is almost always a leak between the old and the new TAVR valve; however, this is usually not a major concern.
- Pushing the old aortic valve to the side can damage the electrical wiring of the heart and may require a pacemaker.
- Most important, the durability of TAVR valves compared with surgical valves is unclear. The TAVR valves may not last as long.
It is important to talk with your heart doctor and heart surgeon to weigh the options for treatment of your aortic stenosis and decide what is right for you.
Published: May 2018
Editorial Team Lead: Priya Kohli, MD, FACC
Medical Contributors: Jacob Dal-Bianco, MD, FACC; Karanvir S. Grewal, MD, FACC; Kameswari Maganti, MD, FACC; Sharon L. Mulvagh, M.D., FACC; Nishath Quader, MD, FACC