Getting diagnosed with severe aortic stenosis (aortic valve stenosis) can leave you wondering what the future holds. After all, it’s a life-threatening condition. Fortunately, treatment advances are helping people with this cardiovascular disease live longer, healthier lives.

Severe Aortic Stenosis Is a Serious Condition

Your aortic valve controls blood flow from the left ventricle (lower chamber of your heart) to your aorta. The aorta is a large blood vessel that brings oxygen-rich blood to the rest of your body. As you age, your aortic valve can narrow and let less blood flow through. This narrowing is commonly caused by deposits of calcium and fat sticking to the valve. It can also occur because of wear and tear, an infection, or a congenital heart condition (one you’ve had since birth).

This narrowing of the valve is called aortic stenosis. It’s one of the most common types of heart valve disease in older adults, particularly those over age 65.

With aortic stenosis, your heart has to work harder to pump blood because the valve is narrower. You may notice symptoms that make it harder to do your usual daily activities. If left untreated, severe aortic stenosis can lead to heart failure and death.

Aortic Stenosis Life Expectancy Without Surgery

A study published in the Journal of the American College of Cardiology found that people with severe aortic stenosis had a two to three times higher chance of death over five years compared to those without the disease.

People who have untreated severe aortic stenosis and symptoms like chest pain and shortness of breath may only live for another one to two years. That’s why treatment can make all the difference in survival rates and quality of life.

Treatment Options for Severe Aortic Stenosis

The two surgeries used to treat severe aortic stenosis are surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). Thousands of these life-saving procedures are performed every year.

For over 50 years, SAVR has been the gold standard for treating severe aortic stenosis. It’s an intensive, open-heart surgery in which the aortic valve is replaced with either a mechanical valve or a bioprosthetic valve (made with animal tissues).

After the procedure, there’s a long recovery that includes cardiac rehabilitation — a program of exercise, education, and support to help improve heart health. You may be a good candidate for SAVR if you’re under 65 years old and can tolerate the stress of major surgery.

TAVR is a newer treatment for severe aortic stenosis. The first TAVR procedure was performed in the United States in 2004. Since then, it’s become the most common treatment option for replacing damaged aortic valves.

TAVR is a less invasive procedure. The surgeon inserts a long, thin tube called a catheter into an artery and up to the heart. Then, a bioprosthetic valve is placed within the existing aortic valve. TAVR can be a better option for people who can’t tolerate intensive, open-heart surgery. The recovery time is generally shorter and less complicated compared to SAVR.

Surgery for Severe Aortic Stenosis Improves Life Expectancy

Severe aortic stenosis usually develops later in life. Although surgery can be dangerous, it’s usually better to treat severe aortic stenosis with valve replacement surgery than to leave it untreated.

One study followed 277 people with severe aortic stenosis who were at least 80 years old. Of the participants, 80 had an aortic valve replacement. The rest didn’t. The participants were followed for five years. After one year, 87 percent of the people who had valve replacement surgery were still alive. And after five years, 68 percent of those people were still alive.

On the other hand, after one year, only 52 percent of participants with severe aortic stenosis who didn’t have surgery were still alive. And after five years, only 22 percent of them were still alive. The findings of this study show that aortic valve replacement surgery may help older people with severe aortic stenosis live longer.

Treatment Improves Life Expectancy for People With Bicuspid Aortic Valves

A normal aortic valve is made of three tissue flaps, or leaflets, that open and close tightly. Some people are born with only two leaflets instead of three. This is known as a bicuspid aortic valve (BAV). BAV is associated with a higher risk of aortic stenosis.

A large study from Sweden followed 5,086 people who had an aortic valve replacement. Five years after treatment, more than 96 percent of the participants were still living. After 10 years, 58 percent of people were still alive. Overall, the study authors noted that participants with BAV and severe aortic stenosis who received a valve replacement had a similar life expectancy as the general population without aortic stenosis.

SAVR vs. TAVR: Which Is Better?

SAVR and TAVR are both standard surgeries for severe aortic stenosis. Each comes with its own set of pros and cons, but is one more effective than the other?

The U.S. Food and Drug Administration (FDA) approved TAVR to treat severe aortic stenosis in 2011. Various studies have looked into whether SAVR or TAVR is a better option. In an observational study, low-risk groups had higher survival rates with SAVR compared to TAVR after 10 years. But this study looked at people with an early version of the TAVR replacement valve, and most other research hasn’t found a difference. The long-term results of TAVR are still being studied.

Another study included 2,841 people who had an aortic valve replacement. There were 325 participants who had TAVR, and 2,516 had SAVR. The study authors found that similar numbers of people from both groups were alive three years after their procedures.

In addition, a meta-analysis of seven randomized trials found no major differences in the rate of death among those with severe AS who had SAVR versus TAVR. A meta-analysis is a study that combines results from several other studies to look for overall patterns.

TAVR May Cause Fewer Short-Term Complications

The chances of survival after SAVR and TAVR may be similar. But each has different risks of complications. Studies show that TAVR may cause fewer immediate complications than SAVR.

One study published in The New England Journal of Medicine followed 1,403 people treated with either TAVR or SAVR. The authors reported that 30 days after treatment, TAVR had a lower chance of the following:

• Atrial fibrillation
• Stroke
• Kidney issues
• Bleeding complications

However, TAVR — especially with self-expanding valves — has been associated with more pacemaker implantations in the long term. Weigh your options with your healthcare team to find out what procedure is best for you.

Talk With Your Doctor

Severe aortic stenosis is a serious condition, but treatments like SAVR and TAVR can help people live longer and feel better. Your age, overall health, and heart condition will help your doctor decide which treatment is best for you. If you’ve been diagnosed with severe aortic stenosis or have symptoms like chest pain or trouble breathing, talk to your doctor. Getting treated early can help you live a longer, healthier life.

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