If you’ve recently been diagnosed with severe aortic stenosis, you’re likely wondering what your treatment options are. Some people might require more complex surgeries, while others could be eligible for less invasive procedures. Your cardiologist will take into account factors such as your age and the severity of your aortic stenosis when helping you make the best choice.

Here, we’ll cover the three most common surgeries used to treat severe aortic stenosis, who makes the best candidate, and the pros and cons of each procedure. This article will help you better understand your treatment options, along with the risks and benefits of each surgery.

What Is Aortic Stenosis?

Your heart has four valves that help blood flow in the correct direction. The aorta is the largest artery, and the aortic valve controls blood flow from your heart to the rest of your body.

Aortic stenosis (or aortic valve stenosis) is a heart valve disease that’s diagnosed when your aortic valve becomes blocked or narrowed. It can be caused by aging, calcium buildup, or infections. As a result, blood can’t flow out of your heart like it normally should, causing symptoms like shortness of breath, angina (chest pain), and syncope (fainting).

When your aortic valve doesn’t shut properly, it lets blood flow backward. This is known as regurgitation, which puts extra pressure on your heart, eventually leading to damage. If left untreated, aortic stenosis can cause heart failure.

According to the American Heart Association (AHA), cases of severe aortic stenosis are life-threatening and need to be treated with surgery. The damaged valve needs to be replaced with a healthy one to make sure blood flows out of your heart properly.

The three types of surgery for severe aortic stenosis are surgical aortic valve replacement, transcatheter aortic valve replacement, and aortic valve repair.

1. Surgical Aortic Valve Replacement

One treatment option for severe aortic stenosis is surgical aortic valve replacement (SAVR). This procedure has been used for more than 50 years and has saved countless lives. SAVR is a type of open heart surgery used to replace the damaged valve.

Although the surgery is more intense and has a longer recovery time, SAVR is a better option for some people. Your cardiologist may recommend SAVR if you:

• Are younger than 65
• Are healthy enough for intensive surgery
• Don’t have healthy enough arteries for minimally invasive techniques
• Require repair of another heart valve or heart bypass surgery for blocked arteries

During this procedure, your surgeon will make a large incision in your chest to access your heart. They’ll remove the damaged valve and replace it with a new one. There are two types of valves used in SAVR. Your surgeon may use a biologic valve from:

• An animal heart, such as a pig or cow
• A healthy donor (in rare cases)
• Your own lung, known as a pulmonary valve

Biological valves are safe and effective, lasting around 15 to 20 years. You won’t be at an increased risk of blood clots, but biological valves do break down over time.

Mechanical valves are the other type of valve used in SAVR. They are less likely to break down as compared to biological valves. However, they increase your risk of blood clots, so you’ll have to take blood thinner medication.

According to Cleveland Clinic, surgeons typically use biological valves in people over the age of 65 and mechanical valves in those 50 or younger. If you’re 50 to 65 years old, you may have either.

A SAVR typically takes two to four hours. After your procedure, you’ll spend five days recovering in the hospital. You’ll then begin a cardiac rehabilitation program to help you regain your strength after open heart surgery. Rehab usually takes at least three months. During this time, you’ll participate in an exercise program and learn how to make heart-healthy lifestyle changes.

2. Transcatheter Aortic Valve Replacement

Another option for replacing your damaged aortic valve is transcatheter aortic valve replacement (TAVR) — also known as transcatheter aortic valve implantation (TAVI). This procedure is minimally invasive and doesn’t require open heart surgery.

Instead, the surgeon uses a long, thin tube known as a catheter to replace the damaged valve. They’ll make a small incision and insert the catheter into an artery. The most common is the femoral artery in your groin, but your surgeon may also choose an artery in your chest, neck, or stomach.

The tip of the catheter contains the new valve. The United States Food and Drug Administration (FDA) has approved several TAVR valves that use animal tissue from cows and pigs on a metal frame. They include:

• Edwards Lifesciences SAPIEN 3 and SAPIEN 3 Ultra valves
• Medtronic CoreValve Evolut R and Evolut PRO valves
• Abbott’s Portico valve

The catheter is guided through your blood vessels to your heart. Once it’s in place, your surgeon will put the new valve inside the damaged one to open it up.

After surgery, you’ll stay in the hospital for a few days to recover. Because TAVR is a minimally invasive procedure, the recovery time is much quicker than open heart surgery. You should avoid intense exercise and activity for 10 days. Within two weeks, you should be able to return to your normal routine. Your cardiologist may also refer you to a cardiac rehabilitation program so you can build strength and healthy habits.

While minimally invasive procedures are less intense and have a shorter recovery period, they’re not an option for everyone. For example, you can’t have TAVR if you have endocarditis (inflammation in the inner lining of your heart) or an aneurysm (a swollen blood vessel).

The type of valve you have can also affect your eligibility. A normal aortic valve has three leaflets or tissue flaps. Some people have a defect that leaves them with only two leaflets (known as a bicuspid aortic valve). If you only have two leaflets, you can’t have TAVR for aortic stenosis.

The life span of a transcatheter aortic valve is uncertain. TAVR is often performed on older people who are considered high-risk candidates for traditional open heart surgery because of advanced age, other health issues, or if they are frail. Because of their age and underlying health conditions, predicting the exact life span of the TAVR valve can be challenging.

3. Aortic Valve Repair

In some cases, your aortic valve can be repaired rather than replaced. If you’re eligible, your cardiologist will perform open heart or minimally invasive surgery to repair the damaged valve.

If you’re experiencing symptoms of severe aortic stenosis and you’re waiting to have a valve replacement, your cardiologist may recommend a balloon valvuloplasty. During this procedure, a catheter with a balloon on the tip is inserted into the narrowed aortic valve. Your surgeon then inflates the balloon to open the valve and allow more blood to flow through.

A balloon valvuloplasty can help relieve some symptoms temporarily, but your valve will eventually narrow again. You’ll likely need a valve replacement to completely treat your aortic stenosis.

Talk With Your Doctor About Your Options

If you’re living with severe aortic stenosis, your cardiologist will work with you to find the best treatment option possible. They’ll take your overall health, other heart and health conditions, and vein health into consideration. Your cardiologist can also help you weigh the pros and cons of each procedure, whether it’s SAVR, TAVR, or a valve repair.

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