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Aortic stenosis and valve replacement

Concord Hospital
Published: 10/20/2021 8:46:06 AM
What is aortic stenosis?

Aortic stenosis is a narrowing of the opening of the aortic valve. This can be caused by a number of things including a congenital heart defect, but it is typically a result of a buildup of calcium on the valve over time. It is a progressive disease graded from mild to severe with many early symptoms unfortunately being mistaken or misunderstood as normal signs of aging. As the ability of the valve to fully open diminishes, oxygenated blood flow to the body is decreased, which can lead to a myriad of problems. Roughly 2.5 million people in the United States have aortic stenosis.

What are the signs and risk factors of aortic stenosis?

Fatigue, shortness of breath, chest pain, rapid heart rates, swollen ankles and feet, and feelings of depression can all be signs of aortic stenosis. Walking even short distances can become very difficult. Everyone is ultimately at risk of developing aortic stenosis, as it is generally a disease of aging; however, people who have undergone radiation therapy, have a history of rheumatic fever or have a deformed aortic valve are at an increased risk. Other risk factors include high blood pressure, abnormal cholesterol, smoking and a family history of aortic stenosis.

How serious is aortic stenosis?

It can be very serious. Patients who develop symptoms of severe aortic stenosis have a 50 percent chance of dying within two years without a procedure to replace the aortic valve. One out of 10 severe, symptomatic patients may have less than six months to live without treatment. Once in the severe range, most cardiologists will recommend valve replacement.

How is aortic stenosis diagnosed and what is the treatment?

Aortic stenosis is diagnosed through a physical examination, including listening to the heart with a stethoscope, and an echocardiogram. Once diagnosed, follow-up echocardiograms are performed at least once per year. Electrocardiography (ECG), chest x-rays and cardiac catheterizations are other tests that may need to be performed. As previously mentioned, when a patient reaches the severe range, aortic valve replacement is generally recommended. Aortic stenosis is a mechanical issue so it requires a mechanical solution. There are no promising pharmaceutical options for treatment. The choice is between surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR).

What is the difference between SAVR and TAVR?

SAVR involves opening the chest, removing the old valve and sewing a new valve in place. This requires general anesthesia, intubation and the use of a heart/lung machine. It is generally a four-hour procedure and the patient stays in the hospital for multiple days afterward. Some rehabilitation may even be required. TAVR is a much more minimally invasive procedure that uses a catheter inserted most often into an artery at the top of a leg. It does not require surgical opening of the chest, so general anesthesia, intubation and the use of a heart/lung machine are unnecessary. It is only usually an hour-long procedure and patients typically go home in the next day or two without the need for rehabilitation.

Dr. Patrick Magnus of the Concord Hospital Cardiovascular Institute is the medical director of the Cardiac Catheterization Lab and Structural Heart Program. He is a board-certified physician in cardiovascular disease, interventional cardiology, nuclear cardiology and echocardiography. Dr. Magnus recently presented on aortic stenosis and valve replacement at the September Concord Hospital Trust “What’s Up Doc?” Donor Lecture Series. The monthly series, supported by the Walker Lecture Fund, features members of Concord Hospital’s medical staff speaking to Concord Hospital Trust donors about new and innovative medical treatments and services. You can watch Dr. Magnus’ presentation on Concord Hospital’s YouTube channel at: youtube.com/concordhospital.

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