What I Wish Heart Patients Knew About TAVR
When the aortic valve in your heart becomes blocked or narrowed, we call that aortic stenosis. Over time, the opening of the valve may become smaller and smaller, so blood cannot flow to the rest of the body. Since the aortic valve is the main heart valve, this problem can lead to serious cardiovascular events or even death. There is no way to prevent aortic stenosis from occurring or delay its progression once it’s found. Once aortic stenosis is detected and it becomes severe, it’s crucial that we replace the valve as soon as possible.
In the past, there was only one way to replace the aortic valve: through open-heart surgery. However, not everyone is an ideal candidate for open-heart surgery—many people are too sick, too old, or have other health concerns, like diabetes, heart disease, or kidney disease. Open-heart surgery may be too risky for them. Unfortunately, the only options until recently were open-heart surgery or no treatment at all. Studies have shown that most patients with severe aortic stenosis die within several years if they are not treated.
But today, things are different. Now, we have a new procedure called transcatheter aortic valve replacement (TAVR), that’s a great option for patients who aren’t a good match for open-heart surgery.
Because the TAVR procedure is fairly new, there’s a lot my patients don’t understand about it. While explaining the condition and procedure to them, I try to emphasize several things:
1. We’ll only perform TAVR in people with severe aortic stenosis, so it’s important to stay on top of your condition.
The symptoms of aortic stenosis are all over the spectrum and tend to get worse as the condition progresses. We classify aortic stenosis as mild, moderate, and severe, depending on how far the narrowing of the aortic valve has progressed. Some patients will feel mild shortness of breath, or they find they can’t exercise for as long or be as active as they once were--their aortic stenosis is more mild or moderate. Other patients experience more significant symptoms, like severe shortness of breath, congestive heart failure, angina (chest pain), or passing out; these patients usually have severe aortic stenosis, and must be treated as soon as possible. Without treatment, 50% of patients with severe aortic stenosis die within two years.
For patients diagnosed with mild or moderate aortic stenosis, the treatment protocol is watchful waiting. We know the aortic stenosis will progress and eventually the patients will need a valve replacement, but we wait to act until the condition is severe. This is because, although we have excellent technologies to replace valves, they’re still imperfect technologies. We know that a replacement valve will degenerate over time, just like the native, or the original, valve did. So if we replace a valve too early, the new valve will need to be replaced again after 10 years. Any time you perform a second operation on a patient, the complications and mortality rate increase. If we had a perfect valve that lasted forever and did not require blood thinners, we would replace a damaged valve right away. But for now, we wait until we absolutely must replace the valve—when the aortic stenosis becomes severe--so there’s less of a chance that the patient will need a second operation in the future.
It’s important that patients with severe aortic stenosis get a replacement as soon as possible, which is why we schedule routine check-ups with patients and keep a close eye on their symptoms. If you feel that your symptoms are getting worse, don’t delay a trip to your doctor.
2. TAVR will help you feel better, but it’s not the solution to all your health problems.
If you’re a candidate for TAVR, it means you’re an intermediate- or high-risk patient: you might be at an advanced age, or have comorbidities like diabetes, kidney dysfunction, heart disease, or other serious health conditions. One thing I emphasize to patients is that, while they will feel markedly better after their TAVR procedure, it won’t fix all of their problems. I think sometimes patients come in with the expectation that it’s an easy procedure that will make them instantly better, and that’s not the case. The valve may be fixed and the heart may be fixed, but their other issues—both mental and physical—are not going to be automatically fixed as well. That’s why it’s so important to have support from family members who will help patients through the recovery and encourage them to continue improving their health.
3. TAVR patients must be committed to the procedure and the recovery to have successful outcomes.
In order to truly benefit from a TAVR procedure, you’ve got to be all in. Sometimes, we’ll meet with a patient to discuss TAVR and then find out that the patient doesn’t really want it—he or she is just feeling pressured by family members. After being a part of more than 400 TAVR procedures, I’ve found that the patients who do poorly are those who are not psychologically ready. Some people, once they reach 80 or 90 years old, don’t want any more medical interventions. The patients who go through it to appease family members tend not to do as well afterwards.
On the other hand, patients who are motivated--who want to get better and have things they still want to accomplish--tend to do better following TAVR.
TAVR is a wonderful technology and a great option for people who, in the past, had no options. And now it’s helping many intermediate-risk people avoid open-heart surgery. But it’s more than just a procedure—the TAVR process includes weeks of testing, driving back and forth to doctor’s appointments, time to recover, and family support. With the right information, you can make the best decision for yourself and your loved ones.
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