You may not need surgery to repair an aortic valve. A nonsurgical catheter procedure with small incisions may be a better option in some cases.
When the aortic valve in your heart stops opening properly and leads to aortic valve stenosis, you can receive the traditional treatment option known as aortic valve replacement surgery.
But if you’re hoping to avoid surgery, your healthcare team could help determine whether it might be possible to get a minimally invasive procedure using catheters and small incisions.
Treating aortic valve stenosis without surgery can lower the chance of surgical complications, ease recovery, and even extend the life of someone with heart disease. But this treatment option is not always possible.
This article will explain what this heart condition means and how the nature of your aortic valve disease and overall health can help determine whether a nonsurgical treatment is an appropriate option.
According to the American Heart Association (AHA), Aortic valve stenosis is among the most common valve problems, affecting an estimated
- arrhythmias (irregular heart rhythms)
- heart failure
- infections of the heart, which can lead to endocarditis
However, with timely aortic valve repair or replacement, healthy heart function can often be restored, and the chance of complications is drastically reduced.
Medications cannot cure aortic valve stenosis, but your doctor may prescribe drugs to manage symptoms or reduce the effect on your heart. This is especially true in mild cases that don’t produce any symptoms and don’t create any significant circulation or heart problems.
Some medications include:
There are a few options that your healthcare team may consider:
- Blood pressure medications:Beta-blockers or calcium channel blockers can help lower your blood pressure.
- Blood thinners: Blood thinners such as Coumadin may be necessary.
- Antiarrhythmics: Medications to manage your heart’s rhythm, called antiarrhythmics, are sometimes prescribed.
While medications can reduce some of the complication risks, they won’t cure or resolve valve stenosis.
If aortic valve repair or replacement is necessary, there are
Balloon valvuloplasty
This procedure is typically done for younger people — especially infants and children — whose stenosis is caused by a narrowed opening above or below the valve. It can also help alleviate symptoms for adults who can’t have other types of valve replacement.
With balloon valvuloplasty, the doctor inserts a catheter fitted with an uninflated balloon at the tip into a blood vessel and guides it into the heart. The balloon is then inflated, expanding the valve opening.
The procedure is sometimes a temporary measure for individuals who will eventually have their aortic valve replaced.
Transcatheter aortic valve replacement (TAVR)
Another less-invasive procedure is called transcatheter aortic valve replacement (TAVR). This is a catheter-based procedure performed to replace the stenotic valve.
TAVR was first performed in 2002 as one of the first nonsurgical options for treating severe aortic valve stenosis. A
During a TAVR procedure, the catheter is inserted either into the femoral artery in the groin (transfemoral approach) or through a small incision in the chest and into a large artery close to the heart (transapical approach).
The replacement is composed of a flexible mesh tube made of nickel, titanium, or similar materials, and leaflets usually made from heart valve tissue from a cow or pig. The folded valve is guided into your aortic valve and is then opened up, occupying the space of the stiff and thickened original valve.
Once the doctor is certain that the new valve is securely in place and is functioning without any leaks or other problems, the catheter is withdrawn, and the incision is closed up, if necessary.
The length of hospital stay is generally less than with the other open-heart surgery, with some lower-risk patients being able to leave the hospital the day after the procedure.
You may be advised to hold off strenuous activity for about 10 days.
In some patients, other approaches through the subclavian artery or chest
There are risks and possible side effects, both from surgical options as well as nonsurgical treatments.
As well tolerated as TAVR usually is, there are some risks. Potential complications include:
- injury to the blood vessels that housed the catheter
- injury to the heart or kidneys
- leakage in the replacement valve because of a poor fit
- need for a pacemaker because of damage to the heart’s electrical system during the procedure
- stroke, whether it’s from a blood clot, aorta plaque, or from dislodged calcium or valvular material
Valve replacement surgery to treat aortic valve stenosis is still a commonly used treatment option but is no longer the most popular procedure.
A 2020 report from the American College of Cardiology noted that the annual number of surgical aortic valve replacement (SAVR) procedures in the United States is 57,626, while the less-invasive TAVR procedure is performed 72,991 times each year.
Successful valve replacement cures aortic stenosis and restores healthy circulation throughout the heart. However, long-term conditions stemming from aortic valve stenosis may have set in before a replacement procedure was performed.
In cases of arrhythmia or heart failure, subsequent treatment for those conditions
Doctors will prescribe aspirin after TAVR to reduce problems such as stroke or embolism. Antiplatelets may also be prescribed, as well as anticoagulants if there’s another reason for them (for example, atrial fibrillation).
Because TAVR has been around only since 2002, there is limited research into its long-term effectiveness. But studies looking at 3- and 5-year outcomes continue to underscore TAVR’s place as a safe and appropriate option to treat aortic valve stenosis.
A 2020 study found that 5-year outcomes for individuals who had TAVR were essentially the same as those who underwent surgical valve replacement. Another 2020 study suggested that among older adults who undergo TAVR, life expectancy and quality of life are comparable to their peers in the general population.
As always, it’s best to consult with your doctor and healthcare team in deciding what’s best — traditional open-heart surgery or a less invasive approach, such as TAVR.
- the patient’s age
- surgical risk
- expected durability of the valve (how long the valve is expected to last)
- patient preferences
The guidelines note that TAVR is generally considered for people at high surgical risk, those who can’t tolerate anticoagulant therapy due to bleeding risk, or those who prefer not to take anticoagulants. They also include people who are 65 years and older.
For people 50 years and younger, traditional surgical valve replacement is generally advised because mechanical valves have higher durability.
Treating aortic valve stenosis without surgery is an increasingly common approach for people of all ages. Catheter-based procedures, particularly TAVR, are less invasive than open-heart surgery, allowing for a shorter, easier recovery.
And because health outcomes are comparable between surgery and TAVR, it’s important to discuss nonsurgical treatment with your doctor if your aortic valve needs to be replaced.