If you’ve recently been diagnosed with severe aortic stenosis (aortic valve stenosis), you may be wondering what your future holds. Since severe aortic stenosis is a life-threatening condition, getting proper treatment as soon as possible is important. Fortunately, new advances in treatment and surgery are helping people with this disease live longer, healthier lives.
In this article, we’ll discuss treatment options for severe aortic stenosis and how they improve life expectancy. We’ll also cover research comparing the two most common types of aortic valve replacement surgeries and how treatments continue to evolve.
Your aortic valve controls blood flow from the left ventricle (lower chamber of your heart) to your aorta. This large blood vessel is responsible for bringing 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 is known as aortic stenosis. It’s one of the most common types of heart valve disease in older adults, particularly over the age of 65.
With aortic stenosis, your heart has to work harder to pump more blood through a narrowed valve. Over time, you may start to notice symptoms that affect your ability to carry out normal day to day activities. If left untreated, severe aortic stenosis can be life-threatening and eventually lead to heart failure.
A study published in the Journal of the American College of Cardiology found that people with untreated severe aortic stenosis had lower survival rates (the chance of surviving after a certain period of time). Specifically, researchers found that only 33 percent of people with untreated severe aortic stenosis were still alive after five years of the study. For comparison, 81 percent of people who didn’t have aortic stenosis were still alive after five years.
Severe aortic stenosis is a serious condition that greatly impacts a person’s quality of life, as well as overall life expectancy. Luckily, treatments for severe aortic stenosis help increase life expectancy and lessen the risk of further health complications.
Today, there are two surgeries used to treat severe aortic stenosis — surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). Thousands of these procedures are performed every year, saving many lives.
For over 50 years, SAVR has been the gold standard for treating severe aortic stenosis. It’s an intensive, open-heart surgery that has a lengthy recovery period and requires cardiac rehabilitation. During the procedure, your aortic valve is replaced with either a mechanical valve or bioprosthetic valve. SAVR is used to treat severe aortic stenosis in people for whom surgery is a low-risk option. You may be a candidate if you’re under 65 years old and can tolerate intensive surgery.
TAVR is a relatively new 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 minimally invasive procedure that uses a long, thin tube known as a catheter. It’s inserted into an artery and sent up to the heart. Using the catheter, a bioprosthetic valve is placed within the existing aortic valve. Since TAVR is minimally invasive, it’s a great option for people who can’t tolerate intensive, open-heart surgery. It typically has a shorter recovery time.
After aortic valve surgery, your doctor will discuss post-operative care, including cardiac rehabilitation and medications such as blood thinners.
Severe aortic stenosis mainly affects the elderly. While there are additional risks for surgery in older adults, research shows that it’s better to treat severe aortic stenosis with valve replacement surgery than to not treat it.
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, while the rest did not. They followed participants for five years and found that 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 to live longer.
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), and it’s associated with a higher risk of aortic stenosis.
A large study from Sweden followed 5,086 people who had received an aortic valve replacement. The authors found that after treatment, more than 96 percent of the participants were still alive after five years, and 58 percent of people were still alive after 10 years. Overall, the authors noted that participants with BAV and severe aortic stenosis who received a valve replacement had similar life expectancy as the general population without aortic stenosis.
SAVR and TAVR are both standard surgeries for treating severe aortic stenosis. Each comes with its own set of pros and cons, but is one more effective than the other?
Since TAVR is still a relatively new procedure, we don’t know as much about its long-term effects. The U.S. Food and Drug Administration (FDA) first approved TAVR for treating severe aortic stenosis in 2011.
Now, researchers are starting to look into whether SAVR or TAVR is a better option. One study looked at 2,841 people who had an aortic valve replacement; 325 participants had TAVR and 2,516 had SAVR. The study authors found that similar amounts of people from both groups were alive three years after their procedures.
Several other clinical trials have also found that SAVR and TAVR have similar survival rates and outcomes from the procedures. As more people continue to have TAVR, doctors and researchers will be able to learn more about its long-term effects.
While the chances of survival after SAVR and TAVR are similar, there are some differences in the risk of complications. Studies show that TAVR may cause fewer complications as compared to SAVR.
One study published in The New England Journal of Medicine looked at 950 people treated with SAVR or TAVR. The authors found that 30 days after treatment, people who underwent TAVR had lower rates of stroke, atrial fibrillation (a type of abnormal heart rhythm), and death when compared to people who underwent SAVR.
Another study published in the same journal followed 1,403 people treated with either TAVR or SAVR. The authors reported that 30 days after treatment, TAVR had a lower chance or incidence of the following:
If you’d like to learn more about your prognosis (outlook) while living with severe aortic stenosis, talk to your doctor or cardiologist. They can go over your individual risk factors and discuss your treatment options.
Research shows that aortic valve replacement for severe aortic stenosis can help people live longer, healthier lives. While this may seem daunting — especially for older adults — it is something to consider. Shared decision-making between you and your doctor can help you determine which treatment is best for you.
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