As the graying of the world’s population continues, people are enjoying healthier lives for longer than ever. At the same time, longer lifespans are contributing to higher rates of age-related diseases, including aortic valvular stenosis.
The aortic valve
is located between the heart’s left ventricle and the aorta, which is the main artery leading away from the heart. A normal valve has 3 leaflets, or tissue flaps, that open when blood is pushed out through them. After the blood flows out, the leaflets automatically close to prevent blood from flowing back into the heart.
Aortic valvular stenosis is a condition where the opening in the heart’s aortic valve becomes narrowed, usually due to calcium build-up, reducing the amount and speed of blood flowing through the valve. The heart must then pump harder to force enough blood through the narrowed valve.
The condition is progressive, worsening with time and the effects of the aging process. A person with aortic stenosis may not have any noticeable symptoms for the initial 10 to 20 years of the disease. After the onset of symptoms — the most common are chest pain, dizziness, fatigue and shortness of breath
— the condition can progress rapidly and usually becomes life-threatening within 2 to 3 years unless the valve is repaired or replaced.
Milder cases generally don’t require surgery, but your doctor will monitor the condition for further narrowing of the heart valve and may recommend lifestyle changes for improved health. For patients whose aortic stenosis progresses to the severe stage, surgery becomes necessary.
SAVR Open Heart Surgery
For people with severe aortic stenosis, surgical aortic valve replacement, or SAVR, is an open heart surgical procedure during which the surgeon removes the narrowed aortic valve and replaces it with a prosthetic valve — typically made from metal or animal tissues. During open heart surgery, a large incision is made down the middle of the chest and abdomen, and access to the heart is created by cutting through the breastbone.
The surgery, which takes about 4 hours to complete, has an excellent success rate, but given the nature of open heart surgery, the patient is subjected to significant blood loss, physical trauma and scarring, and post-surgery healing and recovery can take many weeks, if not longer.
Low Risk Only
Another limitation of traditional open heart surgery is the fact that many patients with severe aortic valvular stenosis don’t meet the qualifying requirements to be candidates for the surgery. These patients are deemed “high surgical risk” based on a variety of factors, including age — severe aortic stenosis is most common among patients in their 70s or 80s — overall health, the condition of their aortic valve, or the presence of another chronic disease, ruling them out for open heart surgery.
The TAVI Breakthrough
While open heart surgery is still considered the best option for patients with aortic valvular stenosis who have a low surgical risk, those in the medium-to-high surgical risk categories finally have a potentially life-saving surgical option. Transcatheter Aortic Valve Implantation surgery
, TAVI for short, is a minimally invasive surgical procedure that is proving highly effective for restoring the health of patients with severe aortic valvular stenosis who need a new heart valve but don’t meet the “low surgical risk” requirement for traditional SAVR open heart surgery.
The TAVI procedure, which is performed under general anesthesia or intravenous sedation, begins with the surgeon inserting a balloon-tipped catheter into an artery through a tiny incision in the groin area. The surgeon guides the catheter through to the aorta, where the balloon is inflated to open up the heart valve. The surgeon then inserts the replacement valve into the catheter and guides it through the artery until it reaches the heart, where it is maneuvered into position.
No Valve Removal
For some types of replacement valves, the balloon is inflated in order to secure or “lock in” the position of the replacement valve inside the patient’s damaged valve, which remains wrapped around the newly implanted valve. Unlike valve replacement surgery, the damaged valve doesn’t need to be removed during TAVI surgery.
TAVI surgery takes about 90 minutes to 2 hours from start to finish, and patients typically stay in the hospital for about 5 days before returning home to continue their recovery. By comparison, SAVR surgery typically requires a hospital stay of around 10 days after surgery.
Understanding Potential Risks
As with all surgeries, TAVI involves some level of risk and potential side effects. Your doctor will explain the risks involved during the process of deciding the best treatment option based on your individual health situation and preferences.
Bumrungrad Heart Valve Center
floor, Bumrungrad International Clinic (BIC) Building
Tel: +66 2011 3415
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