Aortic stenosis is a degenerative condition that develops as a result of scarring and calcium formation on the flaps of the aortic valve. When the heart squeezes, the heart ejects blood through an open aortic valve, thereby delivering blood to meet the body’s demands. In adults, scarring of the aortic valve flaps, or leaflets, restricts the valve’s ability to open and reduces the flow of blood through the aortic valve. This condition is called aortic stenosis. Patients with severe aortic stenosis may experience symptoms of chest discomfort, shortness of breath, or even fainting and these symptoms are associated with an increased risk of premature death.
In the past, the only successful treatment of aortic stenosis has been open heart surgery which involves removal of a patient’s aortic valve and replacing it with a new, artificial valve. Although this operation has an excellent track record of success, many patients with aortic stenosis are not ideal candidates for major open heart surgery due to coexisting medical illnesses or advanced age.
Transcatheter aortic valve replacement (TAVR or TAVI) is a revolutionary minimally invasive treatment alternative for many patients with aortic stenosis. In this procedure, a team of cardiologists and cardiothoracic surgeons threads a catheter-mounted heart valve through either a puncture in the femoral artery or through a small chest incision. The new TAVR valve is positioned within the patient’s old damaged valve, then it unfolds and pushes aside the malfunctioning original aortic valve. The new TAVR valve immediately begins functioning, restoring normal blood flow without subjecting the patient to an open heart operation. In the United States, 98% of patients who undergo TAVR are able to have the TAVR valve inserted through a puncture in the femoral artery (a large blood vessel in the groin), often without the requirement for general anesthesia. Head to head comparisons of transcatheter aortic valve replacement versus open surgical aortic valve replacement in patients considered to be at increased risk of surgical complications have demonstrated that TAVR patients achieve similar results to patients who underwent open heart surgery – but with fewer complications and shorter hospital stays!
In the age of great technological advancements in the treatment of valvular heart disease, patients with significant aortic stenosis should seek out a specialty heart team, composed of both cardiologists and cardiac surgeons, so they may explore both surgical and transcatheter treatment options for the treatment of aortic stenosis.