Aortic Stenosis
Saint Luke’s Valve Center is dedicated to the use of new transcatheter valve replacement therapies for patients with complex valve disease. We were one of the first hospitals in the country—and the first in Kansas City—to offer transcatheter aortic valve replacement, a key option for patients who may be too high risk for traditional valve replacement.
The Valve Center unites a highly-skilled team of cardiologists and cardiovascular surgeons who offers diagnosis, evaluation, and treatment in one convenient location. By having all our specialists together, you won’t experience the extra stress of rushing from building to building for appointments. And you’ll have access to the latest therapies and clinical trials.
Patients who are deemed inoperable or too high risk for traditional open heart surgery may undergo a new procedure called transcatheter aortic valve replacement (TAVR). This new procedure allows the diseased native heart valve to be replaced without open heart surgery. In addition to treating patients too high risk for standard surgery, ongoing research studies only available at Saint Luke’s have allowed us to consider patients who are lower risk for this novel procedure. Potential advantages of transcatheter aortic valve replacement (TAVR) for such patients may include fewer complications and a more rapid and less painful recovery period.
The TAVR procedure was first performed in France in 2002. More than 20,000 patients worldwide have received this heart valve. Saint Luke’s Mid America Heart Institute was one of the first U.S. hospitals to implant this valve.
Aortic Stenosis
Heart Valve Problems: Aortic Stenosis
Aortic stenosis means your aortic valve has a problem opening. The aortic valve is one of the heart’s four valves. It's on the left side of the heart. It sits between the left lower chamber (left ventricle) and the large blood vessel that sends blood to the body (aorta). With aortic stenosis, the left ventricle has to work harder to push the blood through the valve. In some cases, this extra work will make the muscle of the ventricle thicken. In time, the extra work can tire the heart and cause the heart muscle to weaken.
Stenosis usually gets worse slowly, over many years. But sometimes, it can quickly get worse.
Possible causes
Calcium deposits can form on the aortic valve as you get older. These deposits make the valve stiff and hard to open. In some cases, you may have been born with an abnormal aortic valve. Or your aortic valve may have been damaged by rheumatic fever or a heart infection. Radiation therapy used as treatment for cancers such as lymphoma, may be a cause.
Treating aortic stenosis
In many cases, treatment won’t be needed unless you have symptoms. If you do have symptoms, medicines may help ease them. If the stenosis is severe, your healthcare provider may advise surgery to replace the valve. Or you may have a catheter-based procedure (transcatheter aortic valve replacement or TAVR) to replace the valve, even if you don’t have symptoms.
Understanding TAVR
Understanding Transcatheter Aortic Valve Replacement (TAVR)
Transcatheter aortic valve replacement (TAVR) is a procedure to replace a diseased aortic valve with a new tissue or biologic valve. The old heart valve is not removed but works like an anchor for the new heart valve. This procedure is done through small incisions using a long thin tube (catheter), X-rays, and ultrasound. Transcatheter aortic valve replacement is also known as transcatheter aortic valve implantation (TAVI).
The aortic valve directs blood flow from the heart (left ventricle) into the aorta (large blood vessel) and carries blood to the rest of the body. In some people, the valve becomes scarred and stiff and has trouble opening. This is a condition called aortic stenosis. The heart then has to work harder to push blood through the narrowed heart valve to the rest of the body. Over time, the extra work can cause the heart muscle to weaken. This may lead to symptoms, such as tiredness, shortness of breath, chest pain, and fainting. It can lead to heart failure.
In TAVR, the catheter is usually placed in the femoral artery in your groin. Sometimes, the catheter is placed through the axillary artery near your armpit or the carotid artery in your neck. Occasionally, the catheter is placed through a small incision in your chest underneath the collarbone or an incision between the ribs. The doctor uses the catheter to bring the new valve to your heart. The new valve is made of cow or pig heart tissue and is mounted on a metal frame. The new valve helps improve blood flow from the heart to the rest of the body.
Reasons for TAVR
TAVR may be a option for some people instead of surgical aortic valve replacement (SAVR). This will be based on age, surgical risks, how severe your aortic stenosis is, other medical factors, and other cardiac issues. Your healthcare team will determine if TAVR is an option for you.
Risks and possible complications
TAVR is very effective in most people. However, all medical procedures carry some risks and possible complications. Some common risks of TAVR include:
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Bleeding or the need for a blood transfusion
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Anemia (not enough red blood cells in the blood)
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Blood clots
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Infection
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Collection of fluid around your heart (pericardial effusion)
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Confusion or memory problems
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Damage to the heart
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Damage to your blood vessels
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Failure of the new valve
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Heart attack
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Heart rhythm problems that may need a pacemaker
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Kidney damage or failure
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Lung puncture
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Stroke
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Risks of anesthesia (including death)
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Rarely, the new heart valve can move out of position after it has been implanted
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Leaking of blood in or around the new heart valve
You may have other risks, depending on your medical condition. Be sure to talk with your healthcare provider if you have any concerns before the procedure.
Life after a heart valve replacement
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A new heart valve can help ease symptoms you may have had. These include pain or pressure in your chest, shortness of breath, and tiredness.
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After the surgery, you will need to take aspirin or other blood-thinning medicine every day. You will likely also need to take an antiplatelet medicine for a certain period of time. These medicines help prevent blood clots in your new valve.
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You will need to take antibiotics before you have dental work and certain other medical procedures, as prescribed by your healthcare provider. This is to help prevent bacteria from harming your new heart valve.
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Your healthcare provider may tell you to make some lifestyle changes to protect your heart and make it stronger. These include exercise, quitting smoking, and keeping a healthy weight.
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After your recovery from TAVR, you may be able to return to regular activities. You should notice improvement in the symptoms from your heart valve disease. Be sure to talk to your healthcare provider before starting any exercise program.
