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Aug 05, 2019

Heart Disease and Aortic Stenosis Remain a Challenging Combination

Experts address challenges in performing transcatheter aortic valve replacement in patients with heart disease.

Treating patients with both heart disease and aortic stenosis remains a challenge, based on a recent review of transcatheter aortic valve replacement published in the Journal of the American College of Cardiology.

Transcatheter aortic valve replacement (TAVR) is a minimally-invasive procedure used to treat patients with a narrowed heart valve, called aortic stenosis. TAVR offers an alternative to open heart surgery and has been proven safe and effective in a wide variety of patients. However, its use in patients with heart disease is still a matter of debate, as outlined in the recent state-of-the-art review.

According to the review, about half of patients eligible for TAVR have heart disease, which can complicate the procedure and outcomes for a few reasons.

First, some studies suggest that patients with heart disease face greater risk of complications from TAVR. Complications can include increased risk of heart events, bleeding, hospitalization, the need for revascularization, and death. For patients with heart disease, it’s not always clear if the risks of TAVR outweigh the benefits.

Additionally, experts note that the timing of TAVR can be challenging in patients with heart disease. The question remains whether diseased arteries should be treated before or after TAVR. If narrowed arteries do require treatment, doctors are still trying to determine how much time should pass in between procedures and when to administer medications to reduce risk of complications.

Authors also note that performing heart procedures on patients after TAVR may be difficult, as access to certain parts of the heart may be limited.

Given these challenges, authors encourage a thorough workup before TAVR to inform treatment decisions. In the past, the workup included coronary angiography, which uses a small catheter to assess narrowed or blocked arteries. However, a less invasive test called CTA (computed coronary angiography) is now available and may be preferable in TAVR candidates. Not only is the test non-invasive, it can help identify which patients have existing heart disease and may be considered high risk for the TAVR procedure.

However, according to authors, we still have more to learn about performing TAVR in patients with heart disease. Experts anxiously await results of ongoing clinical trials and believe findings will help inform treatment guidelines and improve patient outcomes.

Read the review in the Journal of the American College of Cardiology.

Questions for You to Consider

  • What is aortic stenosis and how does it progress over time?

  • Aortic stenosis occurs when the aortic valve does not open fully, which can obstruct normal blood flow and put extra stress on the heart. Aortic stenosis can start out mild, but worsen over time as the area of the aortic valve decreases lessening the amount of blood flowing from the heart. Patients with aortic stenosis should be continually monitored by a cardiologist to track the progression of this condition, and strenuous activity should be avoided in those with moderate to severe aortic stenosis.
  • What is transcatheter aortic valve replacement (TAVR)?
  • TAVR is a minimally invasive procedure used to repair faulty aortic valves in patients with aortic stenosis. Although surgical valve replacement is considered standard treatment for patients with severe aortic stenosis, TAVR is typically reserved for patients considered too high-risk for traditional surgery.

Infographic: Heart Valve Disease

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