Aortic valve stenosis affects about 1.5 million people in the United States. It’s a progressive disease in which the aortic valve begins to narrow. As a result, the heart has to work harder and harder to pump blood through an increasingly smaller opening. People with aortic stenosis, which is also known as a heart valve failure, tend to develop symptoms like chest pain, an irregular heart rhythm, or episodes of fainting, and they may even experience heart failure or cardiac arrest.
For many years, their best option was open-heart surgery to remove the diseased valve and replace it in order to restore the natural flow of blood. But the surgery was not risk-free, since it was both invasive and left a significant incision afterward. That eliminated the surgery as an option for some people at intermediate or high risk for complications, either from age or other health conditions that could be problematic. In other words, they weren’t healthy enough to undergo the surgery.
In 2008, the U.S. Food and Drug Administration approved a new type of surgical procedure to help people with aortic stenosis who were considered too high risk for the regular procedure. Transcatheter aortic valve replacement (TAVR) suddenly opened up new possibilities for them.
Could it be a good possibility for you? Consider these benefits:
1. TAVR is less invasive than traditional surgery.
During a traditional surgery, the surgeon has to cut through the entire chest wall and expose the heart. That can require a ten-inch-long incision, plus trauma to the muscles and tissues in the chest. The surgical team would stop your heart temporarily and put you on a heart-bypass machine to keep blood pumping through your body while they replace the valve.
By comparison, TAVR is considered a minimally invasive procedure. During the surgery, the surgeon guides a long flexible tube called a catheter into an artery through openings in the ribs or near the groin. At the end of the catheter is a small balloon-like device that opens up and widens the artery. That allows the surgeon to thread another narrow catheter through the artery to carefully deliver and place the replacement valve. The surgeon doesn’t actually remove the diseased valve, however. The old valve remains, but the new valve is nudged into its spot to function in its place.
2. There is a smaller incision.
Since the surgical team doesn’t have to open up the entire chest to put the new valve in place, the patient doesn’t wind up with a long incision that is subject to possible infection. TAVR patients experience far less discomfort compared to conventional surgery, and that makes breathing far more comfortable. Plus, you’ll wind up with a much smaller scar.
3. There is a lower risk of complications with TAVR.
TAVR is less likely to cause many of the complications that are associated with open heart surgery. Since the patient’s heart isn’t stopped and doesn’t have to be put on the cardiopulmonary bypass machine during surgery, that eliminates one potential area in which things can go awry. Also, the procedure carries a lower risk of bleeding during or after the surgery.
4. Less time is spent in the hospital.
Generally speaking, a minimally invasive procedure and a smaller incision means a shorter healing period. People who undergo TAVR often get to go home from the hospital sooner—usually within three to five days—and some are even ready to be discharged after 48 hours. They can usually return to a modified version of their typical lifestyle within a few days. That can be great news for many people who dread an extended recovery time, particularly if they are planning to return to work.
5. TAVR means faster healing.
A less invasive procedure also means a shorter healing period in general. Since there’s less trauma to the chest structures and a smaller incision, a patient who undergoes TAVR experiences less pain than someone who undergoes a more invasive traditional valve replacement surgery, which means they may need less pain medication. And that also can enable them to return to their regular activities of daily living more quickly.
But it’s not risk-free.
TAVR is less risky in many ways than traditional valve replacement surgery. It must be said, however, that TAVR is not a risk-free procedure. It does carry possible risks, such as bleeding, injury to the access artery, bruising at the puncture site, blood clots, kidney failure, infection, and heart attack. And like any procedure that requires anesthesia, it carries the risk of an adverse anesthetic episode.
Compared to open heart valve replacement surgery, TAVR carries an increased risk for stroke and transient ischemic attack (TIA), a short-lived mini stroke that can serve as a warning for actual strokes in the future. It’s critical to learn the warning signs of stroke and call for emergency assistance immediately if you detect any of them.
If you suffer from aortic stenosis, discuss the benefits and risk of TAVR with your physician. Depending on your health and circumstances, it could be a good option for you.
