The definitive treatment for aortic stenosis is the replacement of the diseased aortic valve. This involves replacing the diseased aortic valve with either a biological (tissue) valve or mechanical valve.
Treatment for aortic stenosis will depend on how advanced the condition is and the symptoms that may be present in the patient. When symptoms and diagnosis reveal the condition is mild, treatment may not be urgent and a doctor may instead advise for regular monitoring by a family physician or Cardiologist.
However, if the aortic stenosis is advanced and symptoms are present, a cardiologist may advise for a patient to consider treatment.
The main treatment options for aortic stenosis are:
There are two types of valves for the treatment of aortic stenosis, biological and mechanical.
A biological (tissue) valve is commonly made from pig or cow tissue and typically lasts around 15-20 years before the patient will need an additional replacement valve.
Mechanical valves are made of carbon fibre and considered very durable and reliable devices. They typically won’t need to be replaced, although they do require blood-thinner medications such as warfarin. The patient with the assistance of their cardiologist and associated doctors will discuss which option is most suitable for them, the stage and symptoms of their aortic stenosis.
Surgical aortic valve replacement (SAVR) is a treatment option for aortic stenosis that takes place during an open-heart procedure, where the sternum (bone in the centre of your chest) is divided to visualise the heart. The patient may be placed onto a heart-lung machine for the duration of the procedure.
SAVR may be the suggested treatment option if the patient is also requiring other treatments on the heart to avoid the patient having another open-heart procedure.
Cardiothoracic Surgeon, Dr Dominic Parry further explains the benefits in the below video, as well as the two types of valves used in SAVR, their key differences, and durability.
Following the procedure, patients will often need close monitoring and may spend a few days in the intensive care unit (ICU). Every individual is different and will recover in varying times, although typically, it may take up to 8 weeks1.
A transcatheter aortic valve implantation (TAVI) is a less invasive treatment option for aortic stenosis.
During TAVI, there are typically three main incision locations:
Interventional Cardiologist Dr Ronen Gurvitch discusses the procedural steps for a patient receiving TAVI. “TAVI is a procedure which essentially replaces or implants a new heart valve in the aortic position of a patient with aortic stenosis.” He also discusses the typical process for the patient, from being admitted into the hospital, encouraging their mobility after the procedure and being discharged the next day.
Transcatheter means that the procedure is performed through a thin tube (catheter). Therefore, during a TAVI procedure, the replacement aortic valve will be delivered into position using thin catheters via the large arteries within the patient. An overall written step-by-step of the procedure is below:
1. A small incision is made into the most suitable location and a wire covered in sheath travels to the heart
2. Once this sheath is in place, the new aortic valve is delivered through the catheter that is already in place
3. The new aortic valve is placed in position within the diseased valve and a balloon is inflated to open and increase the size of the existing valve
4. The new valve is put into place within the old valve, and the catheters are removed from the heart.
5. The new valve will begin working when the catheters are removed, and testing is performed to ensure it is functioning as it should be.
There are multiple commercial varieties of TAVI available, most are similar in principle but may differ in actual clinical application when deploying each valve within the heart.
Balloon valvuloplasty is a treatment option that is typically reserved for patients with severe aortic stenosis and for patients who may be considered too high risk or frail for open heart surgery. It involves a balloon being inserted into the diseased aortic valve, then inflated and deflated, with the aim of opening the size of the aortic valve, and potentially reducing the effects of the patients’ symptoms3. This treatment is often considered temporary though, since the aortic valve may typically return to the same state as before.
Balloon valvuloplasty may also be performed to assess the patients’ responsiveness to the treatment before considering an alternative treatment. Additionally, it may be performed as a bridge to a SAVR or TAVI procedure, if the patient needs to recover or physically prepare for a further procedure4.