A Minimally Invasive Alternative to Open Heart Surgery

If you experience chest pain, dizziness and/or shortness of breath when you exercise, talk to a doctor about your symptoms. It’s possible that you could have aortic stenosis, a condition that causes unpleasant symptoms because the aortic valve in your heart has narrowed.All of the oxygen-rich blood that circulates throughout your body exits your heart through the aortic valve. If the valve narrows, it limits the amount of blood that your heart can send to the rest of your body, which can cause health problems.Aortic stenosis is often age-related, caused by calcium buildup on the aortic valve. As calcium deposits narrow your valve opening, less oxygen-rich blood flow reaches your organs. This can cause dizziness, chest pain or shortness of breath when you exert yourself. Your heart works harder while it tries to push blood through the narrow valve opening. Over time, the strain could lead to heart attack or heart failure.If aortic stenosis symptoms impact your quality of life, your doctor may recommend aortic valve replacement. For many years, the only way to replace the aortic valve was through open heart surgery. In recent years, a minimally invasive treatment called transcatheter aortic valve replacement (TAVR) has become the standard of care for the majority of patients with aortic stenosis. The procedure is so safe and effective, it has replaced open heart surgery in most patients aged 65 and older. Open heart surgery to replace the aortic valve, which doctors sometimes recommend, is also a safe option.

Your doctor will make a small incision in your groin area, at the top of your hip bone. They’ll insert an intravenous catheter (flexible tube) through this small opening to gain access to your blood vessel system. The catheter will contain the medical equipment necessary to perform the procedure, including a new, collapsible aortic valve made of biologic material.Using X-ray guidance, your doctor will thread the catheter through your body until it reaches the aortic valve. They’ll position the new valve at the site of your faulty valve.There are two ways for your doctor to expand your new aortic valve. (It must be expanded to work effectively.) Both techniques are available at ChristianaCare:

• Your doctor can place a deflated balloon in the catheter, along with your new, unopened valve. When it’s positioned properly, your doctor can inflate the balloon, which expands the valve.  
• Your doctor can place a self-expanding replacement valve within the catheter. When it’s in position, your doctor can remove the valve’s protective cover, enabling it to open automatically.  

In both cases, the replacement valve will push the faulty aortic valve to the side, so that it’s no longer functional. The new valve will wedge itself in place, using the old valve as an anchor. Your doctor can then remove the catheter and close the small incision in your groin.

Traditional open-heart surgery is more invasive, with a longer recovery period. But for some people, open heart surgery is the right medical decision. Your doctor might recommend open heart surgery instead of TAVR if you need other procedures that require open heart surgery, such as bypass surgery, at the same time. ChristianaCare’s interventional cardiologists and cardiac surgeons, who perform TAVR and open-heart surgery, will tailor their advice to provide you with the best approach for your long-term health.

During open heart surgery:

• You would receive general anesthesia. 
• Surgeons would make an incision in your chest. 
• You would be put on the heart-lung machine (cardiopulmonary bypass) so that surgeons could work on your heart when it wasn’t beating. 
• After surgery, you would spend about a week in the hospital. 
• You would recover at home for three to four weeks before being able to return to your usual activities.  
• You might feel pain or discomfort as your chest incision healed. 

During TAVR:

• You would be given sedation, not general anesthesia. 
• Your doctor would make a small incision in your groin area, not an incision in your chest. 
• The procedure would be performed while your heart was still beating. 
• After TAVR, you’d stay in the hospital for one night, then go home. 
• Your doctor would tell you to avoid heavy lifting for a week, but you’d be allowed to do other normal activities right away, including walking and showering. 
• You might not feel any discomfort at the incision site. 

Many people with aortic stenosis are in their 70s, 80s or 90s. You might have other health conditions that would make you a poor candidate for open heart surgery, or there could be another reason why your doctor thinks TAVR would be best for you.Before TAVR was available, many people who weren’t eligible for open heart surgery simply couldn’t address their aortic stenosis. The problem would become worse over time, leading to heart-related complications and sometimes death.In the decade-plus that TAVR has been available, this newer treatment pathway has become an effective solution for people with aortic stenosis.

If aortic stenosis made you feel winded when you exerted yourself, you may notice right away that you can walk greater distances than you have in years without needing to stop and rest. TAVR fixes your obstructed heart valve, allowing oxygen-rich blood to flow freely from your heart to the rest of your body. The procedure should improve your quality of life, as well as your heart health.

TAVR is performed by interventional cardiologists and heart surgeons. An interventional cardiologist is a special type of cardiologist who receives extra training to learn to perform minimally invasive procedures. They can help improve blood flow within the heart and to the major blood vessels.They strive to offer minimally invasive cardiac procedures that will improve your health without causing a significant decline in your quality of life. If you’ve been diagnosed with aortic stenosis, call 302-733-1000 or request an appointment with an interventional cardiologist to learn about TAVR.