Have Questions About Aortic Stenosis? We Have Answers.

Heart valve disease occurs when one or more of the 4 valves in your heart doesn’t work properly. This can disrupt blood flow between your heart and your body, which can lead to many health problems. There are many types of heart valve disease, including the most common among elderly patients—aortic stenosis.¹

Please see https://www.pulmonicvalvetherapy.com to learn more about congenital heart disease and treatment options available.

A normal aortic valve has three thin leaflets that open and close when the heart beats to regulate blood flow. But about 1% to 2% of people are born with a bicuspid aortic valve, meaning it only has two leaflets. Bicuspid only refers to the number of leaflets within your heart valve and not to the disease itself.

Aortic stenosis is a serious condition that impacts the heart health of millions of Americans each year. This progressive condition is caused by a narrowing of the aortic valve, which prevents normal blood flow. Because the condition gets worse with time, doctors will measure it as mild, moderate, or severe (depending on how damaged the valve is).

There are 4 main causes of aortic stenosis: calcium build-up on the valve leaflets, birth defects that may impact the structure of the aortic valve, rheumatic fever which can cause scar tissue to form in the heart, and radiation therapy.

If aortic stenosis goes untreated, it will progress to the severe stages of the disease. Severe aortic stenosis means the aortic valve has a severe build-up of calcium and has a difficult time opening and closing. Your heart may need to work harder to pump blood throughout your body.

Once aortic stenosis advances to the severe stage, the deadly disease won’t wait for you to delay treatment. As the leaflets become more damaged, the opening of the aortic valve becomes more narrowed and your heart muscle gets weaker. Uncomfortable symptoms such as shortness of breath or fatigue may become more noticeable and can become life-threatening. This is called symptomatic severe aortic stenosis. It is important to tell your doctor right away if you experience symptoms or if your symptoms worsen.

Symptoms of severe aortic stenosis include shortness of breath, chest pain, fatigue, lightheadedness, rapid or irregular heartbeat, swollen ankles/feet or difficulty exercising. These symptoms may indicate your aortic stenosis has progressed to a life-threatening point.

Up to 50% of people who develop severe aortic stenosis symptoms will die within an average of 2 years if they do not have their aortic valve replaced.² If you’ve been told you have severe aortic stenosis, don’t wait until the disease completely disrupts your life before treating it.

No. The only difference is the number of leaflets the aortic valve has. Aortic stenosis is the stiffening of your aortic valve (regardless if you have two or three leaflets), which causes a narrowing of the aortic valve opening. This means the valve cannot fully open and close like it should. The amount of blood pumped with each beat of your heart is reduced, so it’s forced to work harder to supply your body with the blood it needs.

Your doctor will perform a few tests to determine if you have aortic stenosis. This is primarily done by listening to the sounds of your heart with a stethoscope. Diagnosis may also be done through a test called echocardiogram, which uses ultrasound waves to obtain images of the heart chambers and valves.

Depending on how far your aortic stenosis has progressed, your doctor may prescribe medication to help control your symptoms. But it is important to remember: the disease cannot be fixed with medication alone and will continue to get worse until you treat it. This can be done through transcatheter aortic valve replacement (TAVR) or open heart surgery.

Both TAVR and open heart surgery may be treatment options for bicuspid patients. However, only a TAVR Heart Team can determine which treatment option is best for the patient. Those with bicuspid severe aortic stenosis should seek an evaluation with a TAVR Heart Team to see all treatment options available for them.

TAVR (also known as transcatheter aortic valve implantation or TAVI for short) is a less invasive procedure for replacing a diseased aortic valve. During the procedure, your TAVR Doctor will use a catheter to implant a new valve within your diseased valve. TAVR can be performed through multiple approaches; however, the most common is through a small incision in the leg. TAVR procedures can be performed under conscious sedation, rather than general anesthesia.

TAVR can be performed in different ways depending on each individual’s anatomy.

Some approaches include:

• The transfemoral approach (the most common approach and is through an incision in the leg).
• The subclavian approach (through an incision near the shoulder).
• The transapical approach (through an incision in the chest between the ribs).
• The transaortic approach (through an incision in the upper chest).

No, unlike open heart surgery, TAVR does not require stopping the heart.

With the less invasive TAVR procedure, people may return to daily activities sooner than with open heart surgery. People who undergo TAVR get back to life quicker and report improved quality of life following the procedure. Other TAVR benefits may include: shorter hospital stay, relief of symptoms, improved heart function, and reduced pain and anxiety.³

Depending on your health and the procedural approach recommended by your doctor, the average TAVR procedure lasts approximately 1 hour. In comparison, the average open heart surgery lasts approximately 4 hours.³

TAVI stands for transcatheter aortic valve implantation. The procedure and its approaches are the same as TAVR. Your doctor may use the terms interchangeably when discussing your treatment options.

TAVR has been commercially available in Europe since 2007 and in the United States since 2011.

More than 600,000 people worldwide have had a TAVR procedure.

Transcatheter heart valves are made by different manufacturers. You can check which valves are used and available at your hospital. Although you can ask for a specific valve, your TAVR Doctor will recommend the best valve for you.

Learn More About Edwards Transcatheter Heart Valves

You should contact your insurance carrier directly prior to your first appointment with your TAVR Doctor to determine if your TAVR evaluation and TAVR procedure are covered, and if a referral is required.

The Centers for Medicare and Medicaid Services (CMS) cover TAVR under certain conditions. You can learn more by visiting our Helpful Websites page.

Learn More on Our Helpful Websites Page

As with any medical procedure, there is a possibility of risks. The most serious risks of TAVR include death, stroke, serious damage to the arteries, or serious bleeding.

Yes, TAVR may be an option for patients with a bicuspid aortic valve. Open heart surgery is not their only option (although it may be the best option for their unique situation). Only a TAVR Heart Team can determine which treatment option is best for the patient. Those with bicuspid severe aortic stenosis should seek an evaluation with a TAVR Heart Team to see all treatment options available for them.

All severe aortic stenosis patients who are experiencing symptoms should be evaluated for all of their valve replacement options, including TAVR. The American College of Cardiology and American Heart Association have recently updated the guidelines for treatment of severe aortic stenosis. If you were told that TAVR was not an option for you in the past, you may be eligible now.

You need to be evaluated by a TAVR Heart Team at a TAVR Hospital to determine if it is an option for you. You can use our Find a TAVR Hospital tool to identify the nearest location to you.

Your doctor may use one or more of these tests to determine if TAVR is the best option for you.

• Chest X-ray: A type of imaging to view images of the organs and structures inside your chest. You will be placed between a metal plate and the X-ray machine. The X-ray technician will take several images of your chest in a variety of positions. This may take up to 30 minutes to perform.
• Transthoracic echocardiogram (TTE): This diagnostic test (also known as an echo) uses ultrasound to obtain 3D images of the heart. While you are lying on a table, a probe will be placed on your chest wall and will use sound waves to provide detailed pictures of your heart. This usually takes 30-60 minutes.
• Magnetic resonance imaging (MRI): A diagnostic test that uses magnetic and radio waves to take detailed pictures of your heart. You will be asked to lie down on a bed that moves into a large tube. You won’t feel anything but will hear a noise as the images are acquired. You will be asked to lie very still for duration of test.  This usually takes 30-90 minutes.
• Pulmonary function test (PFT): A group of tests, using special breathing equipment, that will measure how well your lungs are moving oxygen to the blood. These can take 60-120 minutes.
• Computerized tomography (CT) scan: An imaging test that uses X-rays to obtain detailed pictures of your heart and blood vessels. You will be injected with contrast dye through an IV. You will be asked to lie down on a bed that passes through a donut-shaped X-ray scanner to take clear images of your heart. This takes up to 60 minutes.
• Angiogram (cardiac cath): An imaging test that uses X-ray and dye to see how blood flows through your arteries and veins. You will lie on your back on an X-ray table. A small incision will be made and a small tube, called a catheter, will be inserted either in your groin or near your elbow. Dye will be injected into the vessel to make the area show clearly on the X-ray pictures. This takes up to 60 minutes.
• Transesophageal echocardiogram: A test that obtains detailed pictures of your heart by inserting a probe down the esophagus (throat). While lying on a table, a technician will spray your throat with medicine to numb and suppress your gag reflex. A thin flexible tube will be guided down your throat. The probe will send and receive sound waves which will become pictures on a video screen. This may take up to 90 minutes.

More people are eligible for TAVR than ever before. TAVR may be an option for anyone with severe aortic stenosis who is experiencing symptoms. Only a specialized TAVR Heart Team can tell you if TAVR is right for you.

To see if the TAVR procedure is right for you, you need to seek out expert care from a specialized heart doctor called an interventional cardiologist at a TAVR Hospital. Only a TAVR Hospital can evaluate you for both TAVR and open heart surgery to determine what the best treatment option is for you.

Not all hospitals perform TAVR, but you can find the nearest TAVR Hospital using the Find a TAVR Hospital Tool.

You may have heard the term Heart Team while researching your aortic stenosis treatment options. A Heart Team is a specialized care team that includes interventional cardiologists, cardiothoracic surgeons, imaging specialists, anesthesiologists, cardiac cath lab staff, and a cardiologist. Together, the specialized Heart Team will conduct a comprehensive evaluation to determine whether the TAVR procedure is appropriate for you.

A VCC is usually your first point of contact at a TAVR Hospital. They are in charge of coordinating all activities regarding TAVR. The VCC provides support to patients from referral to a TAVR Doctor through follow-up from the TAVR procedure. They will help you navigate through the process of evaluation, possible treatment, insurance coverage, and financial needs.

If your doctor doesn’t perform TAVR, you should ask for a referral to a TAVR Hospital. The doctors at a TAVR Hospital are experts in valvular disease and valve replacement and are able to determine the best treatment option for you. Find the nearest TAVR Hospital.

TAVR is becoming an option for more and more people with severe aortic stenosis. If your doctor does not think you are a good candidate for TAVR, you may still contact a TAVR Hospital to receive a second opinion.

Find a TAVR Hospital

With the less invasive TAVR, comes less downtime. Typically following a TAVR procedure, you may be taken to the intensive care unit (ICU) for a little while or moved directly to a recovery room. Your doctor will update your caregiver or loved ones on how you are doing.

The average hospital stay with the TAVR procedure is 3 days; however, some patients have been discharged home as early as the next day.³

Research has shown patient health improvements within 30 days, including the ability to take care of themselves and participate in everyday activities.³

How long your tissue valve will last depends on many patient factors and medical conditions. Follow all care instructions to ensure the best possible results. The Edwards transcatheter valve has been tested in a laboratory to mimic 5 years of use without failure. Regular follow-ups will help your doctor know how your valve is working.

Every year after TAVR you should have a follow-up appointment with your cardiologist, who will be checking your heart. During these visits, your cardiologist will likely perform an echocardiogram and complete other tests to make sure your valve and heart are still working properly. If your cardiologist determines that your valve is no longer working the way it should, your doctor will determine next steps and decide if you need an evaluation for reintervention. If it is determined that another procedure is needed to fix your failing heart valve, and you have previously had a transcatheter heart valve to fix your severe aortic stenosis, you could be eligible to get another transcatheter heart valve placed into your failed artificial valve. This procedure is known as valve-in-valve and is currently approved for patients who are deemed high risk for open heart surgery.

Open heart surgery for aortic valve replacement is where the doctor will open your chest and will completely remove the damaged valve and replace it with an artificial valve. You will be connected to a heart-lung machine that does the work of your heart and keeps the blood flowing throughout your body. Patients usually need to stay in the hospital for a week or more, before beginning a long period of recovery.