The heart’s job is to pump oxygen-rich blood through the body. Blood is pumped to the body through the four chambers of the heart with the help of heart valves. The aortic valve controls the flow of blood as it exits the heart and is pumped to the rest of the body.
Aortic Stenosis: –
More than 1 million cases of Aortic Stenosis are diagnosed per year in India alone. While infections like rheumatic fever was once a leading cause, age related degradation of the aortic valve is fast emerging as the major cause of aortic stenosis in most developed and developing countries today. 1 in 10 people over the age of 75 are likely to be affected by this condition.
These damaged valves are unable to open fully and prevent your heart from getting blood out to the rest of your body. When this happens, your heart needs to work harder to pump blood through the narrowed valve. Eventually, this extra work limits the amount of blood it can pump, and this can cause symptoms as well as weaken your heart muscle over time.
Symptoms of aortic stenosis: –
- Chest pain or tightness
- Feeling faint or fainting
- Feeling tired
- Shortness of breath
- Irregular heart beat & Heart Murmur
Most commonly aortic stenosis is detected in asymptomatic patients who have mild to moderate aortic stenosis when they undergo routine clinical examination for some other medical ailment or a routine health check up by a feeble pulse or harsh murmur on cardiac examination. It is confirmed by an echocardiogram showing a thickened calcified aortic valve, increased thickness of the heart muscle and increased gradients across the aortic valve.Evaluation: –
After a detailed history and physical examination your doctor will conduct further tests like an echocardiogram, Cardiac Catheterization and CT Scans to fully assess the severity of your condition and plan treatment options.
Treatment Options: –
Until recently, one of these options were avalaible…
Balloon Valvuloplasty (BAV)
Where a balloon is inflated to stretch the valve and allow greater flow, however, it is by and large ineffective, as the valve tends to return to its narrowed state within months.
- Surgical Aortic Valve Replacement (SAVR)
Was the mainstay of treatment where your natural aortic valve was removed and replaced with an artificial valve during a major open-heart surgery.
Several cases unfit for surgery due to various reasons were left with only medical management. Severe symptomatic aortic stenosis, if not attended to promptly carries an extremely high mortality rate, almost 90% within 4 years. This is higher than most cancers. So it is very important to seek professional help as soon as possible.
Transcatheter Aortic Valve Implantation (TAVI)
This procedure has been gaining momentum rapidly over the past 10 years. Initially approved only for the extremely high-risk elderly with no other options, the US FDA has now approved its use in the intermediate risk group patients as well. Initial reports from studies comparing its efficacy to surgical valve replacement in low risk patients are also very promising.
In this procedure a thin, flexible tube (catheter) housing the collapsed valve is inserted most commonly through an artery in your leg (transfemoral approach) and delivered to the heart. Similar to coronary artery stenting methods, the entire procedure is performed in a cardiac Cath Lab most often under just sedation and local anesthesia. A temporary pacemaker allows your doctor to control your heart rate as needed. The valve delivery system is used to position the new valve which is then implanted inside the diseased aortic valve and the delivery system is removed.
The Valve: –
The valve is composed of similar tissue (porcine or bovine) used in surgical bio prosthetic valves sewn onto a collapsible metal frame. Three valve leaflets control the flow of blood like your natural valve. As the procedure is fairly new we really don’t know about the longevity of these valves. At some point these TAV heart valves may need to be replaced and how long they last vary from patient to patient. So far, we have 5 – 7 years of data without failure.
This non-surgical technique has come as a boon to many patients who are too sick to have surgery or those who have had previous open-heart surgeries and cannot undergo a re-do surgery due to the significantly higher risks during the 2nd time around or to just simply those who don’t want to have open heart surgery. After a TAVI procedure, most people usually start feeling better right away. The recovery is quite dramatic, with hospital stays ranging only between 3 – 5 days. This low hospital stay drastically reduces its attendant complications and infections are practically unheard off. As the number of procedures increase day by day, the cost of these valves will eventually come down, which will allow more and more Indian patients to benefit from this remarkable procedure.
Dr. Sai Satish M.D., D.M.,
Senior Interventional Cardiologist,
Apollo Hospitals, Chennai, India.