TREATMENT OPTIONS FOR AORTIC STENOSIS
Each year, more than 5 million Americans are diagnosed with valve disease, the most common of which is aortic stenosis (AS). Of the 1.5 million patients who have aortic stenosis, 500,000 have a severe form of the condition, and half of those patients are not experiencing symptoms. Studies show that severe AS is undertreated, so it is crucial to educate yourself on the condition and learn about the various options for treatment.
Aortic stenosis occurs when the opening to the aortic valve narrows. This narrowing can cause reduced or blocked blood flow, forcing the heart to work harder and to become weakened. AS is most commonly caused by calcium build-up but can also be caused by a congenital heart defect or rheumatic fever.
AS ranges in severity from mild to severe and can be symptomatic or asymptomatic (meaning you may or may not experience symptoms). Your treatment depends on the severity of your condition. Your doctor should perform diagnostic tests and factor in your age, heart structure, medical history, symptoms and any other relevant information to determine the best course of action. Keep reading to learn about the most common treatments for aortic stenosis.
Watchful Waiting & Lifestyle Changes
If there are no symptoms or if symptoms are mild, your doctor may advise “watchful waiting,” meaning regular check-ups to monitor the condition. In addition, lifestyle changes will likely be recommended to help prevent the condition from worsening. Mayo Clinic shares some tips for living a more heart healthy lifestyle that your health care provider might suggest:
- Eating a heart-healthy diet. Eat a variety of fruits and vegetables, low-fat or fat-free dairy products, poultry, fish, and whole grains. Avoid saturated and trans fat, and excess salt and sugar.
- Maintaining a healthy weight. Aim to keep a healthy weight. If you’re overweight or obese, your doctor may recommend that you lose weight.
- Getting regular physical activity. Aim to include about 30 minutes of physical activity, such as brisk walks, into your daily fitness routine.
- Managing stress. Find ways to help manage your stress, such as through relaxation activities, meditation, physical activity, and spending time with family and friends.
- Avoiding tobacco. If you smoke, quit. Ask your doctor about resources to help you quit smoking. Joining a support group may be helpful.
While there is no medication that can cure or improve aortic stenosis, your doctor may prescribe medications that can help manage the symptoms and reduce the possibility of complications.
While the aortic valve is almost always replaced, in certain situations, repair may be an option. An aortic valve repair surgery can involve separating valve flaps that have fused, but typically a repair approach occurs when the valve is leaking rather than when it is stenotic.
Surgical aortic valve replacement (SAVR)
SAVR is an open-heart surgery in which the heart is accessed through an incision made in the chest. The affected valve is removed and replaced while the heart is stopped and a heart-lung machine is used to continue blood flow. After the valve is replaced, the heart is restarted and the chest incision is closed. SAVR is considered a major surgery and carries the risk of complications such as blood clots, bleeding, stroke, infection, and heart damage.
SAVR had been considered the primary treatment option for valve replacement, but a new method called TAVR is becoming more and more prevalent as studies continue to demonstrate the safety and efficacy.
Transcatheter aortic valve replacement (TAVR)
During a TAVR procedure, the aortic valve is replaced with an artificial valve delivered by a catheter – a small hollow tube that is inserted into blood vessels. This procedure is minimally invasive and doesn’t require open-heart surgery. Typically, the procedure time and recovery time for TAVR is shorter than SAVR.
While in recent years TAVR was primarily performed on older, sicker patients who were not a candidate for open heart surgery, recent studies have demonstrated that TAVR may a good option for younger patients or for patients who are not necessarily at increased risk for open heart surgery.
One of the main risks of transcatheter aortic valve replacement is stroke, which can occur if debris that breaks off during the procedure travels through the bloodstream and reaches the brain. If you are planning on having this procedure, you may be able to protect yourself from the risk of stroke by using an embolic protection device, which captures and removes the debris from the bloodstream.
Each situation is unique, so be sure to discuss the specifics of your condition with your Heart Team. If you believe you are experiencing symptoms of aortic stenosis but have not yet been diagnosed, it is important that you discuss it with your doctor.
- TAVR Facts & Figures. Available at: https://www.johnmuirhealth.com/services/cardiovascular-services/intervention/transcatheter-aortic-valve-replacement/facts-and-figures.html. Accessed March 12, 2019.
- Aortic Valve Surgery: Procedure Details. Available at: https://my.clevelandclinic.org/health/treatments/16745-aortic-valve-surgery/procedure-details. Accessed March 12, 2019.
- Aortic Valve Stenosis. Available at: https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/diagnosis-treatment/drc-20353145. Accessed March. 12, 2019.
This educational blog was provided by Boston Scientific.