Aortic Stenosis and Transcatheter Aortic Valve Replacement (TAVR)

Up to 1.5 million people in the United States suffer from aortic stenosis, a progressive disease that affects the aortic valve in their hearts. Approximately 250,000 of these patients suffer from severe symptomatic aortic stenosis, often developing debilitating symptoms that can restrict normal day-to-day activities, such as walking short distances or climbing stairs. Aortic stenosis patients can often benefit from surgery to replace their ailing valve, but only approximately two-thirds of them undergo the procedure each year. Many patients are not treated because they are deemed inoperable for surgery, have not received a definitive diagnosis, or because they delay or decline the procedure for a variety of reasons.

Patients who do not receive an aortic valve replacement have no effective, long-term treatment option to prevent or delay their disease progression. Without it, severe symptomatic aortic stenosis is life-threatening.

What is aortic stenosis?

A healthy aortic heart valve allows oxygen-rich blood from the lungs to flow from the left ventricle of the heart to the aorta, where it then flows to the brain and the rest of the body. Severe aortic stenosis causes narrowing or obstruction of the aortic valve and is most often due to accumulations of calcium deposits on the valve’s leaflets Leaflets are flaps of tissue that open and close to regulate the flow of blood in one direction through the valve. The resulting stenosis impairs the valve’s ability to open and close properly. When the leaflets don’t fully open, the heart must work harder to push blood through the calcified aortic valve. Eventually, the heart’s muscles weaken, increasing the patient’s risk of heart failure.

Aortic stenosis is typically a disease of the elderly, as a buildup of calcium on heart valve leaflets occurs as one gets older. It most typically occurs in patients older than 75 years of age. In a minority of cases, a congenital heart defect, rheumatic fever, radiation therapy, medication or inflammation of the membrane of the heart can also cause the valve to narrow.

Symptoms of aortic stenosis 

• Severe shortness of breath leading to gasping – even at rest
• Chest pain or tightness
• Fainting
• Extreme fatigue
• Lightheadedness/dizziness
• Difficulty exercising
• Rapid or irregular heartbeat

Identification of severe aortic stenosis can be confirmed by examining the heart and listening for a heart murmur, which is typical of the disease. This can be performed by using imaging tests such as an echocardiogram or electrocardiogram (ECG or EKG), chest x-ray or ultrasound. Receiving an appropriate diagnosis and getting treated quickly is critical, as once patients begin exhibiting symptoms, the disease progresses rapidly and can be life-threatening.

Treatment of aortic stenosis 

Open-chest surgical aortic valve replacement is the gold standard and an effective treatment of severe aortic stenosis and has been proven to provide symptomatic relief and long-term survival in adults. During the procedure, the damaged “native” heart valve is removed and replaced with a prosthetic valve. Open-chest surgery is recommended for virtually all adult aortic stenosis patients who do not have other serious medical conditions.  

What if I have a serious medical condition?

For patients who have been deemed inoperable or high risk for traditional open-chest surgery, a procedure called transcatheter aortic valve replacement (TAVR) is available as a treatment option.

The Edwards SAPIEN Transcatheter Heart Valve is approved by the U.S. Food and Drug Administration (FDA) as a therapy for patients with severe symptomatic native aortic valve stenosis who have been determined by a by a heart team that includes an experienced cardiac surgeon and cardiologist to be inoperable or high risk for open-chest surgery to replace their diseased aortic heart valve. Patients who are candidates for this procedure must not have other co-existing conditions that would prevent them from experiencing the expected benefit from fixing their aortic stenosis.

Why choose the Wellmont for severe aortic stenosis?

The Wellmont CVA Heart Institute was selected as one of only 70 centers nationwide to offer transcatheter aortic valve replacement. Centers must participate in a rigorous training program. During this comprehensive program, clinicians are trained on appropriate patient selection for transcatheter aortic valve replacement (TAVR), procedure planning and device preparation. Before doctors are able to perform a procedure, they are required to receive training using a hands-on-simulator and must observe several cases performed by other certified doctors with transcatheter aortic valve replacement (TAVR) experience. This rigorous process has been implemented and utilized with the introduction of the Edwards SAPIEN Valve in other parts of the world, to ensure the technology is utilized by skilled operators, so that optimal patient outcomes are achieved.

For more information about transcatheter aortic valve replacement (TAVR) at the Wellmont CVA Heart Institute, please contact us today.