Aortic Stenosis: Understanding the Treatment Options

If you’ve been diagnosed with aortic stenosis (AS), there’s good news: Today’s treatments can get even the oldest, frailest patients relishing life again!

Health Monitor Staff
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Aortic stenosis (AS) occurs when the valve that regulates the flow of oxygen-rich blood from the heart to the aorta, the body’s main artery, becomes narrow, impairing circulation. As a result, the heart has to work harder and harder. All that extra effort puts a strain on the muscle, causing it to weaken. Over time, heart failure can result.

If AS is detected early—when it is still mild and before symptoms occur—doctors may simply monitor the condition, using echocardiograms to find out how well the valve and the heart are functioning. But when stenosis progresses, from mild to moderate to severe—and especially when symptoms such as chest pain, fatigue, difficulty exercising and lightheadedness develop—aortic valve replacement is the only effective treatment. Without a valve replacement, 50% of patients will not survive two years after the onset of symptoms. Fortunately, doctors now have various ways to replace an aortic valve. Here’s a look:

Surgical aortic valve replacement (AVR)

  • What it is: In this open-heart surgery, surgeons remove the diseased valve and replace it with an artificial valve. It requires the surgeon to separate the chest bone to access the heart, a procedure called a sternotomy.
  • Who is a candidate: Patients who are healthy enough to undergo open-heart surgery.
  • What to know: You’ll spend about a week in the hospital, including two days in the ICU. Complete recovery takes about six to eight weeks.

Minimally invasive aortic valve replacement

  • What it is: In this procedure, surgeons do not have to perform a sternotomy. Instead, they are able to replace the valve through smaller incisions that are just two to four inches long.
  • Who is a candidate: To qualify, patients cannot be obese or have other serious health conditions, such as atherosclerosis (clogged arteries) or severe lung disease.
  • What to know: Because a sternotomy is not performed, there is a shorter hospital stay (three to five days), less pain, a lower risk of bleeding and infection.  

Transcatheter valve replacement (TAVR)

  • What it is: A non-surgical technique in which a replacement valve is threaded into the heart through a catheter inserted in an artery. Once the new valve reaches the heart, it is inserted within the diseased valve and expanded. The primary approach is through an incision in the leg (transfemoral), but if the vessels in a patient’s legs are too small, doctors may enter though an incision between the ribs (transapical), through the upper chest (transaortic) or through an artery near the shoulder (axillary).
  • Who is a candidate: Patients for whom open-heart and minimally invasive surgery are too risky. That generally includes older patients (70s, 80s and older) and/or those with other serious medical conditions. 
October 2014