Aortic stenosis is a valve disorder which occurs in approximately 2 percent of people older than age 65. Aortic stenosis is the narrowing of the aortic valve, the heart valve that controls the flow of oxygenated blood from the left ventricle into the rest of the body.
This condition has several causes. Aortic stenosis may be related to a congenital abnormality of the aortic valve called a bicuspid valve, or it may be due to the aging process and atherosclerosis, or hardening of the arteries. In rare cases it may be due to rheumatic fever in the past.
Symptoms come on gradually such as decreased ability to exercise. Later, a patient may develop evidence of heart failure, loss of consciousness or chest pain. If a patient’s aortic stenosis is diagnosed early, they may be followed typically for many years with cardiac ultrasounds (echocardiography).
Once the patient becomes severely symptomatic with aortic stenosis, there is approximately a two-year mortality rate of approximately 50 percent if untreated. Once a patient develops severe aortic stenosis, then he or she may ultimately require heart catheterization prior to consideration of surgery.
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There are two current options for the treatment of aortic stenosis once surgery is needed. One is the traditional median sternotomy, or open-chest technique in which an incision is made and the aortic valve is replaced using cardiopulmonary bypass.
In recent years, another option has become available initially for high-risk patients and now for intermediate-risk patients is called transcatheter aortic valve replacement (TAVR). This procedure is relatively new in the United States but has been done for much longer in Europe. Currently, more than 250,000 people globally have received transcatheter aortic valve replacements.
The technique for transcatheter aortic valve replacement usually involves access through the femoral artery in the groin or a small incision in the chest. The new valve is positioned on a delivery catheter device and is deployed after being placed inside the existing diseased aortic valve. Once expanded to its working size, the new valve crushes the old valve out of the way.
The results of this procedure have been amazingly good considering that it has been done originally in high-risk patients but has now evolved to the usage of it in intermediate-risk patients. After the TAVR procedure, the patient usually can go home in approximately 3-5 days if there are no complications.
Dr. Anthony Rogers, a cardiothoracic surgeon with Baptist Health Medical Group Cardiothoracic Surgery, practices at Baptist Health Lexington.