Aortic Stenosis Overview

What is aortic valve stenosis?

Aortic stenosis is one of the most common and serious valve disease problems. Aortic stenosis is a narrowing of the aortic valve opening. Aortic stenosis restricts the blood flow from the left ventricle to the aorta and may also affect the pressure in the left atrium.

Although some people have aortic stenosis because of a congenital heart defect called a bicuspid aortic valve, this condition more commonly develops during aging as calcium or scarring damages the valve and restricts the amount of blood flowing through.

Does aortic stenosis always produce symptoms?

No. Many people with aortic stenosis, or AS, don’t experience noticeable symptoms until the amount of restricted blood flow becomes greatly reduced.

Symptoms of aortic stenosis may include:

• Chest pain
• Rapid, fluttering heartbeat
• Trouble breathing or feeling short of breath
• Feeling dizzy or light-headed, even fainting
• Difficulty walking short distances
• Swollen ankles or feet
• Difficulty sleeping or needing to sleep sitting up
• Decline in activity level or reduced ability to do normal activities

It may be important to note the person suffering from AS may not complain of symptoms. However, if you or your family members notice a decline in routine physical activities or significant fatigue, it’s worth a visit to your health care provider to check for reduced heart function. Use our AS symptom tracker (PDF) to record your symptoms and frequency, and bring it to your next appointment to review with your doctor.

How does aortic stenosis progress or cause increasing problems?

In addition to the symptoms of aortic stenosis, which may cause a patient to feel faint, weak, or lethargic, the wall of the left ventricle also may show muscular thickening because the ventricle must work harder to pump blood through the narrow valve opening into the aorta.

The thickened wall takes up more space inside the lower heart chamber that allows less room for an adequate amount of blood to be supplied to the body. This may lead to heart failure. Appropriate treatment can help reverse or slow down the progress of this disease.

Who’s at risk for aortic stenosis?

Aging people

Aortic stenosis mainly affects older people as a result of scarring and calcium buildup in the valve cusp (flap or fold). Age-related AS usually begins after age 60, but often doesn’t show symptoms until ages 70 or 80.

Treatment

What is TAVR? (TAVI)

During this minimally invasive procedure a new valve is inserted without removing the old, damaged valve. The new valve is placed inside the diseased valve. The surgery may be called a transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI).

Valve-within-valve — How does it work?

Somewhat similar to placing a stent in an artery, the TAVR approach delivers a fully collapsible replacement valve to the valve site through a catheter.

Once the new valve is expanded, it pushes the old valve leaflets out of the way and the tissue in the replacement valve takes over the job of regulating blood flow.

How is TAVR or TAVI different from standard valve replacement?

This procedure is available for people with symptomatic severe aortic stenosis at low, intermediate or high risk for standard valve replacement surgery.

What is involved in a TAVR procedure?

Usually valve replacement requires an open-heart procedure with a “sternotomy”, in which the chest is surgically separated (opened) for the procedure. The TAVR or TAVI procedures can be done through very small openings that leave all the chest bones in place.

While TAVR is not without risks, it provides beneficial treatment options to people who may not have been considered for valve replacement. A patient’s experience with a TAVR procedure may be similar to a coronary angiogram in terms of recovery. You will likely spend less time in the hospital after TAVR compared to surgical valve replacement.

The TAVR procedure is performed using one of two approaches, allowing the cardiologist or surgeon to choose which one provides the best and safest way to access the valve:

• Entering through the femoral artery (large artery in the groin), called the transfemoral approach, which does not require a surgical incision in the chest, or
• Using a minimally invasive surgical approach with a small incision in the chest and entering through a large artery in the chest or through the tip of the left ventricle (the apex), which is known as the transapical approach.

Who’s a good candidate for this type of valve surgery?

The procedure is available to patients in all risk categories.

TAVR can be an effective option to improve quality of life in patients who otherwise have limited choices for repair of their aortic valve.