Do you have questions about aortic stenosis and its treatment options?

Heart valve disease occurs when one or more of the four valves in your heart don’t work properly. This can cause the blood flow between your heart and your body to be disrupted and can lead to many health problems. There are many types of heart valve disease, including the most common among elderly patients—aortic stenosis.

Aortic stenosis is a progressive condition caused by a narrowing of the aortic valve, which prevents normal blood flow. Because the condition will get worse with time, doctors will measure it as mild, moderate, or severe (depending on how damaged the valve is). The condition affects 1 in 8 people over the age of 75.¹

There are four main causes of aortic stenosis: calcium build-up on the valve leaflets, birth defects that may impact the structure of the aortic valve, rheumatic fever which can cause scar tissue to form in the heart, and radiation therapy.

If aortic stenosis goes untreated, it will progress to the severe stages of the disease. Severe aortic stenosis means the aortic valve has a severe build-up of calcium and struggles to open and close. Your heart may need to work harder to pump blood throughout your body.

Once aortic stenosis progresses to the severe stages, symptoms such as shortness of breath, chest pain, fatigue, or lightheadedness may occur.² It is important to tell your doctor right away if you experience symptoms or if your symptoms worsen.

Symptoms of severe aortic stenosis include shortness of breath, chest pain, fatigue, lightheadedness, rapid or irregular heartbeat, swollen ankles/feet or difficulty exercising.² These symptoms may indicate your aortic stenosis has progressed to a life-threatening point.

Approximately 50 percent of people who develop severe aortic stenosis symptoms will die within an average of two years if they do not have their aortic valve replaced.³ If you have been diagnosed with severe aortic stenosis and have symptoms, talk to your doctor right away about your treatment options.

Your doctor will perform a few tests to determine if you have aortic stenosis. This is primarily done by listening to the sounds of your heart with a stethoscope. Diagnosis may also be done through a test called an echocardiogram, which uses ultrasound waves to obtain images of the heart chambers and valves.

Depending on how far your aortic stenosis has progressed, your doctor may prescribe medication to help control your symptoms. However, it’s important to know the only effective way to treat aortic stenosis is by replacing your valve. This can be done through transcatheter aortic valve implantation (TAVI) or open heart surgery.

TAVI (also known as transcatheter aortic valve replacement or TAVR for short) is a less invasive procedure for replacing a diseased aortic valve. During the procedure, your doctor will use a catheter to implant a new valve within your stenosed valve. TAVI can be performed through multiple approaches, however, the most common is through a small incision in the leg.

TAVI can be performed in different ways depending on each individual’s anatomy.

• The transfemoral approach is the most common approach and is through an incision in the leg.
• The transapical approach is through an incision in the chest between the ribs.
• The transaortic approach is through an incision in the upper chest.

With the less invasive TAVI procedure, people may return to daily activities sooner than with open heart surgery. People who undergo TAVI report improved quality of life following the procedure. Other TAVI benefits include: short hospital stay, relief of symptoms (short-term and long-term), improved heart function, and reduced pain.^4-7

Depending on your health and the procedural approach recommended by your doctor, the average TAVI procedure lasts approximately 1.5 hours. In comparison, the average open heart surgery lasts approximately 4 hours.⁸

How long your transcatheter heart valve will last depends on many factors and will vary per person. However, regular follow-ups will help your doctor know how your valve is working.

TAVR stands for transcatheter aortic valve replacement. The procedure and its approaches are the same as TAVI. Your doctor may use the terms interchangeably when discussing your treatment options.

TAVI has been commercially available in Europe since 2007 and in the United States since 2011.

Transcatheter heart valves are made by different manufacturers. You can check which valves are used and available at your hospital. Although you can ask for a specific valve, your doctor will recommend the best valve for you.

As with any medical procedure, there is a possibility of complications. The most serious risks include death, stroke, vascular complications and a life-threatening bleeding event.

TAVI used to only be available for people who were too weak to undergo open heart surgery. But now, the procedure is available to more people depending on their risk for open heart surgery. You need to consult an interventional cardiologist at a Heart Centre to determine if TAVI is an option for you.

Your doctor may use one or more of these tests to determine if TAVI is the best option for you.

• Chest X-ray: A type of imaging to view images of the organs and structures inside your chest. You will be placed between a metal plate and the X-ray machine. The X-ray technician will take several images of your chest in a variety of positions. This may take up to 30 minutes to perform.
• Transthoracic echochardiogram (TTE): This diagnostic test (also known as an echo) uses ultrasound to obtain 3D images of the heart. While you are lying on a table, a probe will be placed on your chest wall and will use sound waves to provide detailed pictures of your heart. This usually takes 30-60 minutes.
• Magnetic resonance imaging (MRI): A diagnostic test that uses magnetic and radio waves to take detailed pictures of your heart. You will be asked to lie down on a bed that moves into a large tube. You won’t feel anything but will hear a noise as the images are acquired. You will be asked to lie very still for duration of test.  This usually takes 30-90 minutes.
• Pulmonary function test (PFT): A group of tests, using special breathing equipment, that will measure how well your lungs are moving oxygen to the blood. These can take 60-120 minutes.
• Computerized tomography (CT) scan: An imaging test that uses X-rays to obtain detailed pictures of your heart and blood vessels. You will be injected with contrast dye through an IV. You will be asked to lie down on a bed that passes through a donut-shaped X-ray scanner to take clear images of your heart.  This takes up to 60 minutes.
• Angiogram (cardiac cath): An imaging test that uses X-ray and dye to see how blood flows through your arteries and veins. You will lie on your back on an X-ray table. A small incision will be made and a small tube, called a catheter, will be inserted either in your groin or near your elbow. Dye will be injected into the vessel to make the area show clearly on the X-ray pictures. This takes up to 60 minutes.
• Transesophageal echocardiogram:  A test that obtains detailed pictures of your heart by inserting a probe down the esophagus (throat).  While lying on a table, a technician will spray your throat with medicine to numb and supress your gag reflex. A thin flexible tube will be guided down your throat. The probe will send and receive sound waves which will become pictures on a video screen. This may take up to 60 minutes.

Once you are referred to a Heart Centre, make sure you are evaluated for all of your treatment options – including both TAVI and open heart surgery.

You may have heard the term Heart Team while researching your aortic stenosis treatment options. A Heart Team is a specialised care team that includes interventional cardiologists, cardiothoracic surgeons, imaging specialists, anesthesiologists, cardiac cath lab staff, and a cardiologist. Together, the specialised Heart Team will conduct a comprehensive evaluation to determine whether the TAVI procedure is appropriate for you.

Typically following a TAVI procedure, you may be taken to the intensive care unit (ICU) for a little while or moved directly to a recovery room. Your doctor will update your caregiver or loved ones on how you are doing.

Research has shown that patients that undergo the less invasive TAVI procedure have improved quality of life and a shorter recovery time. To optimize your recovery, your doctor will give you specific instructions, which may include a special diet, exercise, and medication therapy. It is important to carefully follow your doctor’s directions, especially if blood-thinning drugs are prescribed.

Open heart surgery is another option for treating severe aortic stenosis. Compared to TAVI, it is a more invasive surgery in which the patient is placed under general anaesthesia.

Typically, during open heart surgery, the surgeon will make an incision across the full length of your chest to access your valve. Sometimes open heart surgeries can be performed through smaller incisions (called minimal incision valve surgery). Your old aortic valve will be taken out and a new one will be placed in your body.

After open heart surgery, it can take the body a long time to recover. Your chest that needed to be opened during the operation takes several months to heal completely. Cardiac care rehabilitation is recommended to help with this recovery process. Rehabilitation after heart valve surgery usually takes three to four weeks.

As with any medical procedure, there is a possibility of complications. Serious complications, sometimes leading to re-operation or death, may be associated with open heart surgery. Other risks include stroke, infection, bleeding, abnormal heart rhythms, heart attack, kidney problems, etc.

There are many free patient resources available to learn more about aortic stenosis and TAVI, including patient stories, procedure videos, and brochures.

You can search for Heart Centres near you by using our Heart Centre locator.

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