If you’ve recently been diagnosed with severe aortic stenosis, you’re likely wondering about the various treatment options. 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 overall health when helping you make the best choice.
Here, we’ll cover the three procedures 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.
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).
In aortic stenosis, when your aortic valve doesn’t open properly, it puts extra pressure on your heart. Similarly, when the valve fails to close properly due to changes in structure from stenosis, it can cause blood to flow backward (regurgitation). This extra pressure can damage or weaken the heart. If left untreated, aortic stenosis can cause heart failure.
According to the American Heart Association (AHA), cases of severe aortic stenosis are life-threatening. The diseased valve needs to be replaced with a functioning valve to make sure blood flows out of your heart properly.
The three types of procedures for treating or managing severe aortic stenosis are surgical aortic valve replacement, transcatheter aortic valve replacement, and aortic valve repair. Decisions on which procedure may be best for you are typically discussed among a multidisciplinary heart team including cardiologists and surgeons.
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 diseased valve.
Although the surgery is more intense and has a longer recovery time, SAVR is a better option for some people. Your cardiologist will refer you to a specialist or team of specialists to determine the best treatment option for you. You may be a candidate for SAVR are if you:
During this procedure, your surgeon will make an incision in your chest to access your heart. They’ll remove the diseased valve and replace it with a new one. The two primary types of valves used in SAVR are bioprosthetic and mechanical.
A bioprosthetic valve is made from animal tissue, such as from a pig or cow, and may also contain human-made parts.
Less commonly, a purely biologic valve may come from:
Bioprosthetic valves work well and last around 12 to 15 years. Some people may need to undergo more than one valve replacement in their lifetime. They 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 durable, often made with titanium or carbon, and less likely to break down as compared to biological valves. However, mechanical valves increase your risk of blood clots, so you’ll have to take blood thinner medication if you have this type of valve.
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 about 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 outpatient exercise program and learn how to make heart-healthy lifestyle changes.
Another option for replacing a diseased aortic valve is transcatheter aortic valve replacement (TAVR) — also known as transcatheter aortic valve implantation (TAVI). This procedure is minimally invasive compared to open heart surgery. These procedures are typically performed by a specially trained interventional cardiologist in collaboration with a cardiac surgeon.
The doctor uses a long, thin tube known as a catheter to replace the diseased valve. They’ll insert the catheter into an artery, usually the femoral artery in your groin. Your doctor may also choose an artery in your chest, neck, or stomach, but these are much less commonly used.
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 (also known as bioprosthetic valves). They include:
The catheter is guided through your blood vessels to your heart. Once it’s in place, your doctor will put the new valve inside the damaged one to open it up.
Cleveland Clinic notes that many people can leave the hospital within a day of the procedure. Others may need a longer time in the hospital to recover. Because TAVR is minimally invasive, the recovery time is much quicker than open heart surgery. You should avoid intense exercise and activity for several 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. Your doctor will help evaluate your overall health condition to determine if TAVR is a good option for you. For example, TAVR is not a good option if you’ve had a recent heart attack or stroke or if you have a cardiac mass or infection. Certain other heart, lung, kidney, and bleeding problems may also affect your ability to undergo a TAVR.
The structure of your current valve could also affect your eligibility. For example, 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), which could determine whether a TAVR is a feasible option.
TAVR was previously approved for people with severe aortic stenosis who were experiencing symptoms and considered at high risk of death or serious complications from an open heart valve replacement surgery. In 2019, the FDA expanded the indication to include people with severe aortic stenosis at low risk of death or serious complications from open heart surgery.
New research is being conducted on the life span of a transcatheter aortic valve. An article from 2023 analyzed more than 230,000 TAVR cases. Among them, fewer than 1,900 required another valve intervention within 10 years — an incidence of 1.63 percent.
Additionally, a recent trial found that people with severe aortic stenosis deemed low risk for open heart surgery had better outcomes with TAVR than SAVR at the one-year mark. The group that received TAVR had a lower incidence of death, stroke, and rehospitalization.
It’s important to note that risks remain with any valve replacement procedure. Your doctor will help you understand the risks and benefits of TAVR or SAVR.
If you have severe aortic stenosis, you may wonder if valve repair is an option instead of valve replacement. In severe aortic stenosis, the aortic valve is too diseased to repair, so valve replacement is required to treat the condition. However, there are certain situations where repair may be appropriate.
A minimally invasive procedure called balloon valvuloplasty may be recommended as a short-term option to relieve symptoms before undergoing a valve replacement. The benefits of balloon valvuloplasty tend to last for about six months. This procedure may also be recommended if you are not a candidate for a replacement for reasons related to your unique health history.
During a valvuloplasty procedure, a catheter with a balloon is inserted into the narrowed aortic valve. Your doctor then inflates the balloon to open the valve and allow more blood to flow through.
Open heart valve repair is almost never used for severe aortic stenosis.
If you’re living with severe aortic stenosis, your cardiologist will work with you and a team of specialists to find the best treatment option possible. They’ll take into consideration your overall health, heart conditions, and vein health. The heart team 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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