Aortic Valve Disease: Understanding Valve Replacement and TAVR (video/podcast)

Feeling tired, short of breath or lightheaded may seem like normal signs of aging. But when these symptoms persist, they could be signs of a serious problem with the heart’s aortic valve.

Aortic valve disease affects the valve that controls blood flow from the heart to the rest of the body. While treatment used to be traditional open-heart surgery, minimally invasive valve replacement offers new treatment options for many people with aortic valve disease.

In this video, Curtiss Stinis, MD, an interventional cardiologist at Scripps Clinic Anderson Medical Pavilion in La Jolla, discusses aortic valve disease and how transcatheter aortic valve replacement, or TAVR, is expanding treatment options with San Diego Health host Susan Taylor.

Four valves direct blood through the heart. The aortic valve is the last valve blood flows through; it is a one-way valve designed to allow blood to freely leave the heart to go to the rest of the body.

Aortic valve disease occurs when the valve becomes narrowed or begins to leak. The most common type, aortic stenosis, develops when calcium builds up on the valve over time. This causes the opening to become increasingly narrow, making it more difficult for the heart to pump blood out to the body.

Aortic stenosis becomes more common with age, particularly after age 65. Risk factors can also include a family history of heart valve problems and previous radiation treatment to the chest.

The other major type of aortic valve disease is aortic regurgitation, also called aortic insufficiency. In this condition, the valve does not close completely, allowing blood to flow backward into the heart. Over time, a severe leak can cause the heart to enlarge and weaken.

Aortic valve disease can develop gradually, and people may not realize that their symptoms are related to their heart.

Common aortic valve disease symptoms include:

• Fatigue or decreased energy
• Shortness of breath, particularly with physical activity
• Lightheadedness or fainting
• Reduced ability to exercise
• Swelling or fluid retention in the legs

While these symptoms can easily be mistaken for normal aging or being out of shape, Dr. Stinis says certain patterns should be checked by a physician.

“If symptoms seem really out of proportion to other folks in their age range, if they continue to happen day after day, or if there’s a consistency to them where they happen more with exertion, I would be more concerned,” he says.

It is also worth paying attention if a spouse, family member or friend notices a change.

“If a spouse or loved one brings symptoms to their attention, that’s more typical of a significant underlying medical condition than just normal aging,” adds Dr. Stinis.

Doctors typically diagnose aortic valve disease with an echocardiogram. This imaging test uses sound waves to create pictures of the heart and assess how well its valves are working.

Medications can help manage some symptoms and related conditions, but when aortic valve damage becomes severe, replacing the valve may be necessary.

For many years, valve replacement required open-heart surgery. That remains an important treatment option, but surgery can carry greater risks for older adults and people with other medical conditions.

TAVR offers a less invasive alternative for many patients. Instead of opening the chest, doctors insert a replacement valve through a thin flexible tube called a catheter.

The catheter is usually inserted through a blood vessel in the groin and guided to the heart, where the replacement valve is positioned inside the patient's existing aortic valve.

Following TAVR, most patients spend one night in the hospital. Dr. Stinis says patients generally can walk, drive and perform light activities during the first five days. After that, depending on the patient’s individual circumstances, physical restrictions are typically lifted.

Until recently, TAVR was primarily used to treat aortic stenosis. That’s because calcium buildup in a narrowed valve helps anchor the replacement valve. Patients with aortic regurgitation often had little to no calcium in their valve.

A newly approved TAVR device is designed to address that problem. The device uses small structures called locators to secure the replacement valve to the patient’s existing valve tissue.

Dr. Stinis compares the device to “a giant spring” that grips the surrounding tissue and stays in place.

The device is currently approved for patients with severe aortic regurgitation who are considered at high risk for open-heart surgery. Clinical trials are continuing to evaluate its potential use in healthier patients.

Aortic valve disease can be serious, but it is treatable. The key is recognizing when changes in energy or exercise ability may signal something more than normal aging.

If the symptoms are persistent or consistently occur with physical activity, Dr. Stinis recommends talking with a doctor. If valve replacement is recommended, minimally invasive treatment advances are providing more options than ever.

“I think it’s an exciting time for valvular technology,” says Dr. Stinis. “You’re going to see more and more of these minimally invasive procedures as time goes on.”