Treatment for Aortic Stenosis

By

Marijke Vroomen Durning, RN

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Unlike the Valentine images of pink and red cartoon hearts, the human heart is really a fist-sized muscle divided into four chambers. Your blood enters and exits each chamber via your valves, which open and close to control blood flow and keep blood going in one direction. The aortic valve controls how much blood leaves your heart and enters your blood stream, but it can develop a condition called aortic stenosis, in which the valve opening narrows. When this happens, the blood flow through the valve slows and your heart reacts by pumping harder as it tries to compensate.

Determining Your Treatment Path

If you’ve been diagnosed with aortic stenosis, your cardiologist will determine how severe your condition is in order to direct your treatment. Surgery to replace the valve is necessary to treat the condition, as there aren’t any medications that can manage or slow down the narrowing. However, your cardiologist may prescribe medications to treat related issues, such as high cholesterol or high blood pressure.

Typically, the valve isn’t replaced until the patient experiences symptoms and the aortic stenosis is considered to be severe. Common symptoms include shortness of breath, fatigue, and chest pain (called angina). If you don’t have symptoms yet but your doctor has noticed your valve is narrowing, you will likely have regular checkups and echocardiograms of your heart to monitor the stenosis. If you’re experiencing symptoms, talk to your doctor about valve replacement as soon as possible.

Treatment Options

If you have been diagnosed with severe aortic stenosis causing symptoms that affect your quality of life, your cardiologist will refer you to a cardiac surgeon to open or replace your aortic valve. These are the procedures that may be considered:

Open-heart surgery: Open-heart surgery is the most common treatment for severe aortic stenosis. After your cardiac surgeon makes an incision down the center of your chest, your sternum (breast bone) is divided so your surgeon can see and have access to your heart. The narrowed aortic valve is removed and the replacement is inserted. The surgery can take anywhere from three to five hours, and you may need to spend as long as a week or more in the hospital for recovery.

Transcatheter aortic valve replacement (TAVR): TAVR, also called transcatheter aortic valve implantation (TAVI), is a minimally invasive procedure and doesn’t require open-heart surgery. This procedure is usually reserved for people who have a high or intermediate risk of suffering from complications during open-heart surgery.

TAVR is performed in an operating room and can take between one and three hours to complete. First, your cardiac surgeon will make a small incision in your groin to reach your femoral artery, although sometimes other arteries are used. The surgeon will then insert a long catheter (tube) into the incision, and thread it up through your artery to your heart and the aortic valve. Using the catheter, the surgeon will insert a new valve over the old one; the new valve will immediately push the old valve’s flaps out of the way and begin working. The replacement valve may be synthetic or biologic, made from human or animal tissue.

Most people are up and about within a day or two of the procedure, although you may remain in the hospital for three to five days so your doctor can monitor your heart and your recovery.

Balloon valvuloplasty: This procedure doesn’t replace your aortic valve but it opens the narrowing instead. It’s done the same way as TAVR, through a catheter threaded to your heart. When the catheter reaches the aortic valve, a balloon is inflated and this pushes the opening wider. Because the effect of the balloon valvuloplasty isn’t permanent and the narrowing usually returns, it may be done to allow for more time before open-heart surgery is performed. This procedure is typically only performed in children with congenital aortic stenosis, because replacing the valve altogether is the best option for adults.

Care After Valve Replacement

If you’ve had a mechanical valve implanted, the likelihood of it failing is small, but you may be at risk for developing blood clots. To reduce this risk, you will probably have to take anticoagulants (blood thinners) for as long as you have the valve. Biologic valves have a higher failure rate over the long-term, but the risk of blood clots is lower. Speak with your cardiac surgeon about your options so you can decide which type of procedure and valve is right for you.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Feb 8, 2017

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