Health & Medicine

Options for aortic valve replacement expand

Ender's Game, starring Asa Butterfield as Ender Wiggin, debuted at the top of the weekend's box office chart.
Ender's Game, starring Asa Butterfield as Ender Wiggin, debuted at the top of the weekend's box office chart.

Aortic stenosis is a narrowing of the aortic valve, which allows blood to flow from the heart's lower left chamber, the ventricle, into the aorta, a large blood vessel that carries blood to the rest of the body.

About 1.5 million people in the United States have aortic stenosis, making it the most common heart valve disease in America. Of these, about 250,000 people have severe symptomatic aortic stenosis. Each year about 50,000 people undergo traditional aortic valve replacement, an open-heart surgical procedure. However many patients can't undergo the operation.

Symptoms that are traditionally associated with aortic stenosis include shortness of breath, chest pain, fainting, extreme fatigue and a rapid or irregular heartbeat. Most patients with aortic stenosis are diagnosed by undergoing an echocardiogram, a type of ultrasound of the heart. Cardiac catheterization also plays a role in the evaluation of aortic stenosis.

When a patient becomes symptomatic from aortic stenosis, we usually recommend a traditional aortic valve replacement. However, some patients do not qualify for this traditional surgery because of advanced age or severe COPD and other medical illnesses. These patients might be able to undergo transcatheter aortic valve replacement, a minimally invasive procedure done through small incisions. This procedure was a treatment option in Europe several years before it was approved for use in the United States in November 2011.

There are three options for the this kind of replacement of the aortic valve. One involves going through the femoral artery in the groin. Another involves going through a small anterior chest incision and the apex of the heart. The third involves a transaortic approach through a chest incision.

There are several strict criteria that each patient must meet to be eligible for a transcatheter aortic valve replacement. Patients should seek an experienced cardiac surgical center for the evaluation and determination of eligibility for this surgical approach.

Patients are usually hospitalized for three to four days compared to seven to eight days with the traditional approach. Best of all, with this procedure, patients commonly return to regular activity within about four weeks and have an improved quality of life much more quickly than those who undergo traditional valve replacement surgery.