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What are Possible Treatment Options for Severe Aortic Stenosis (AS)?

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Medical Management and Balloon Valvuloplasty

Patients with severe AS who are too sick for surgery may take medications that help control irregular heartbeats or prevent blood clots. These medications may help control your symptoms for a period of time; however, without aortic valve replacement, severe AS could worsen to a more serious condition.

In addition to medications and if your physician determines appropriate, a procedure called balloon valvuloplasty can be performed to relieve symptoms. It is a non-surgical procedure that is performed by placing a balloon into the aortic valve and inflating the balloon. Balloon valvuloplasty does not treat severe AS, which could worsen to a more serious condition without valve replacement.

Risks

Medical management and balloon valvuloplasty do not treat severe AS or alter its progression. Risks will vary, so talk about adverse risk events with your doctor.

 

Surgical Aortic Valve Replacement (SAVR)

Surgical aortic valve replacement surgery is an effective, life-saving treatment option for some people with severe AS. Depending on your risk factors, such as health, diagnosis, and age, your healthcare providers will be able to recommend the appropriate valve replacement for you.

A traditional aortic valve replacement surgery often requires a median sternotomy, where the sternum is split down the middle (some are performed without splitting the sternum). The chest is then opened with special retractors. This provides the surgeon with necessary access to the heart and chest cavity, in order to replace your aortic valve.

Risks

Because each patient has his or her unique medical history, risks will vary, so talk about adverse risk events with your doctor.

Summary of Surgical Aortic Valve Replacement

  • General anesthesia
  • Patient on heart-lung bypass machine
  • Chest open, 7-inch incision (often, but alternatives exist)
  • Valve replaced during 2-4 hour procedure (typical)
  • 12 day hospital stay (typical)
 

CoreValve Transcatheter Aortic Valve Replacement (TAVR)

The CoreValve transcatheter aortic heart valve is made of natural tissue obtained from the heart of a pig. The leaflets that control the flow of blood are secured to a flexible, self-expanding metal frame (nickel-titanium) for support. The CoreValve aortic heart valve is available in four sizes with different diameters. Your doctor will determine which valve size is right for you.

The CoreValve aortic valve is implanted via a thin, flexible tube (catheter). It is a less invasive treatment option than open heart valve surgery.

CoreValve TAVR Image

 

Where Does the Catheter, Which Holds the Valve, Enter My Body?

Depending on your vessel anatomy, your doctor will determine if the thin, flexible tube (catheter) should enter via the artery in your leg (femoral artery), the artery in your neck (subclavian artery), or through a space between your ribs (direct aortic approach). The direct aortic approach for CoreValve device placement involves additional steps to access your heart, making the procedure more invasive. Discuss the risks with your physician.

Catheter Image