The aorta is the major blood vessel that arises from the heart and travels through the chest down to the lower body. Various diseases can affect the aorta, damaging or weakening the artery. High blood pressure, smoking and family history of aortic disease are the major risk factors. Many aortic problems are asymptomatic and are frequently discovered incidentally during tests for other conditions. Aneurysms of the aorta are areas where the aorta is enlarged to greater than one and a half times the normal diameter. Aneurysms are best repaired electively before complications develop.
Aortic Valve Stenosis
Those with aortic valve stenosis – when the aortic valve tightens or narrows, preventing blood from flowing through normally – affects tens of thousands of Americans each year, mostly women. Patients who have aortic valve stenosis may feel chest pain or tightness, shortness of breath and have difficulty exerting themselves, particularly when exercising. Sometimes, they don’t have any symptoms and the stenosis can go undetected. If not treated, severe aortic stenosis can lead to heart failure and/or sudden death. Without treatment, it is likely that 50 percent of patients with aortic valve stenosis will not survive more than an average of two years after the onset of symptoms.
Up until now, the only treatment for this disease has been open heart aortic valve replacement surgery, but TAVR offers new hope for patients with this condition who are unable to have surgery due to sickness, weakness or being too high risk for an open heart procedure.
Severe Aortic Stenosis
In elderly patients, severe symptomatic aortic stenosis is often caused by the build-up of calcium (mineral deposits) on the aortic valve’s leaflets (flaps of tissue that open and close to regulate the one-way flow of blood through the aortic valve). This build-up of calcium on the leaflets impairs the aortic valve’s ability to fully open and close. As a result, the narrowed valve allows less oxygen-rich blood to flow from the lungs to the brain and rest of the body which may cause symptoms like severe shortness of breath and extreme fatigue.
While open-chest surgery to replace the aortic valve is the gold standard treatment for severe symptomatic aortic stenosis, there are some patients who are not eligible for surgery or considered at high risk for surgery. These patients may be candidates for a therapy called transcatheter aortic valve replacement (TAVR), which allows Heart Teams to replace a diseased aortic heart valve without open-chest surgery. TAVR enables the placement of a balloon-expandable heart valve into the body with a tube-based delivery system called a catheter. This tube-based system allows the valve to be inserted through an incision in the leg and into an artery (transfemoral procedure), or through an incision between the ribs and then through the bottom end of the heart called the apex (transapical procedure). The transapical procedure is only available to certain high-risk patients who are not candidates for the transfemoral procedure because they do not have appropriate access through their leg artery.
A Heart Team will conduct a comprehensive evaluation to determine whether the TAVR procedure is an appropriate therapeutic option. In certain cases, TAVR may not be an option because of co-existing medical conditions or disease processes that would prevent the patient from experiencing the expected treatment benefit or because the risks outweigh the benefits. For those who are candidates for TAVR, this therapy may provide relief from the often debilitating symptoms associated with severe symptomatic native aortic valve stenosis.
Aortic Disease Clinic
Cardiac Surgery (Aortic Disease)