Minimally invasive treatment options for aortic valve replacement

Until just a few years ago, aortic valve replacement through open-heart surgery was the only way to fix aortic stenosis, a serious heart problem that develops when calcium buildup makes the passage in the aorta more narrow.

It’s a common problem, especially as we age. Most patients are in their 70s and up.

Aortic stenosis is a very serious issue. Patients are out of breath. They retain fluid, and their legs swell. Sometimes they experience chest pain. If untreated, half of patients die within three years of developing symptoms.

Thanks to advances in technology and techniques, patients now have two options for valve replacement: traditional open-heart surgery and transcatheter aortic valve replacement or TAVR, a much less invasive procedure. The amazing thing about TAVR is that it gives people the ability to feel better without major interruption in their lives.

With open-heart surgery, patients stay in the hospital for five to seven days. There is a lengthy recovery time, typically four to eight weeks. It can be a rough road, and some patients find the recovery period debilitating.

Through TAVR, we can deliver the new valve through an artery in the leg, much like a cardiac catheterization. We use a biological heart valve, which we believe lasts about 15 years, although we don’t know for sure because the medical community is still collecting data. It is made from the lining of a pig heart or a cow heart, which is sewn onto a scaffold and begins working right away. This is similar to the valves that are placed with open heart surgery.

Initially, there was a concern that the risk of stroke was greater for TAVR than for open-heart valve replacement. But more recent studies indicate the stroke risk is the same as for open-heart surgery. The length of stay is much shorter. Patients can expect to go home from the hospital 24-36 hours after the procedure.

The first TAVR patients were mostly very frail and elderly, people who could not safely tolerate open-heart surgery. But as techniques and equipment improve, more patients are choosing TAVR. We perform about 150 of these procedures each year at Christiana Care’s Center for Heart and Vascular Health.

TAVR is not for everyone. The equipment used to introduce the valve is approximately 6 millimeters in diameter, so it won’t work in people whose arteries are smaller than that. When we started using TAVR, only five years ago, it was 8-9 millimeters, so we expect the equipment to get even smaller in the future.

Other risks include damaging the blood vessels or the heart itself. The risk of requiring a pacemaker is higher with TAVR than with open-heart surgery. There also is a risk of bleeding at the site where equipment is inserted.

We realize it’s a complicated decision for patients and their families. That is why we bring together a multidisciplinary team with both an interventional cardiologist and a cardiac surgeon to address everyone’s questions and concerns. Together, we can make the best choice.