Aortic Stenosis
Aortic Stenosis Treatment
Treatment for aortic stenosis depends on how far the disease has progressed. If the patient's stenosis is mild, medication may be prescribed to regulate the heart, prevent blood clots, and manage symptoms. However, medication is a palliative therapy and is not an effective treatment for severe aortic stenosis. The only effective treatment for severe aortic stenosis is to replace the diseased aortic valve. This can be done with open heart surgery or transcatheter aortic valve replacement (TAVR).
TAVR Procedure - Transcatheter Aortic Valve Replacement
TAVR is less invasive than open heart surgery. It uses a catheter to replace the heart valve instead of opening up the chest and completely removing the diseased valve. The bioprosthetic valve used during TAVR is inserted within the diseased aortic valve. The valve is crimped onto a balloon that is expanded and pushes the leaflets of the diseased valve aside.
Open Heart Surgery
During open heart surgery, the surgeon removes the diseased aortic valve and replaces it with either a mechanical valve (made from man-made materials) or a biological valve (made from animal or human tissue), through a median sternotomy or a small right anterior thoracotomy (minimally invasive approach).
The only effective treatment for severe aortic stenosis is to completely replace the diseased aortic valve.
Each patient receives detailed instructions after the procedure to ensure a full recovery. They are encouraged to stay active during the recovery process. While on pain medication, patients are discouraged from driving or operating heavy machinery.
Typically a patient will spend about one to five days in the hospital, depending on the approach used in the TAVR procedure.
The TAVR screening process utilizes a patient-focused multidisciplinary team approach. Not only will the patient meet with an interventional cardiologist, but they will see two separate surgeons to help determine the right approach. Other members of the team include the TAVR nurse coordinator, anesthesiology, cath lab and operating room staff, and imaging specialists. CHI St. Vincent’s interdisciplinary heart team meets weekly to review cases and plan the best approach for each patient.
The screening process for TAVR is extensive, and includes a complete medical history, an EKG, and an echocardiogram. If the patient is deemed to be a good candidate for surgery or TAVR, cardiac catheterization is performed to exclude significant coronary artery disease. A CT of the chest is performed to evaluate the anatomy of the heart.
Other tests may include a CT of the abdomen and pelvis, a chest x-ray, ultrasound of the arteries in the neck, and pulmonary function studies. Additional studies may be ordered by the physicians based on an individual’s specific conditions.
As with any procedure, there are a few risks. Some of the risks for TAVR include bleeding at the catheter insertion site, vascular damage, infection, abnormal heart rhythms, and stroke. These and other risks will be discussed during the screening process.
Some of the advantages of TAVR include shorter hospital stays and quicker recovery times. In addition, many TAVR procedures are done under sedation instead of general anesthesia.
For patients who have been deemed high or greater risk for traditional open-chest surgery, a procedure called transcatheter aortic valve replacement (TAVR) may be a treatment option. TAVR allows the aortic valve to be replaced, and like open-heart surgery, TAVR produces results in improving patients’ quality of life and lifespan. Patients with a history of stroke, prior chest radiation, prior open heart surgery, COPD, frailty, renal insufficiency, advanced age, and other conditions may be appropriate for TAVR.
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