Our heart has four valves that keep blood flowing in the right direction. They are the mitral valve, tricuspid valve, pulmonary valve and last but not least, the aortic valve. During each heartbeat, the “doors” in each valve open and close; allowing blood to flow throughout the body via our circulatory system.
In aortic valve stenosis, the aortic valve that is situated on the left chamber of the heart does not open completely; causing the aortic valve opening to be narrowed. When this happens, the heart is then required to work extra hard to ensure enough blood is pumped into the aorta and the rest of the body.
In this article, Consultant Cardiologist Dr. Ong Sea Hing from The Cardio Clinic walks us through aortic valve stenosis and the various treatments available, including transcatheter aortic valve implantation (TAVI).
Symptoms of aortic stenosis typically involves shortness of breath, lethargy, chest pain as well as dizzy spells. However, those who have led relatively sedentary lives may not experience such symptoms. If not identified in time, the narrowing of the valve can lead to heart failure and even sudden death.
According to Dr. Ong, the average lifespan for someone living with severe aortic stenosis without any treatment is about one to five years; depending on the severity of their condition.
For the longest time, aortic valve stenosis has been considered a death sentence to the elderly, where the condition is most prevalent in. This is because treatment requires an open heart surgery where the aortic heart valve is replaced under general anesthesia over several hours. According to Dr. Ong, elderly patients with comorbidities face greater risks too.
“In the past, more than 30% of patients were denied treatment (open heart surgery) as they are deemed at too high a risk. Contributing factors include their age and existing medical issues,” he added.
An open heart surgery for valve replacement can put tremendous strain on the body and therefore, is not considered the best option for the elderly or those with comorbidities.
Unlike an open heart surgery where an incision must be made to the chest for the hours-long valve replacement surgery to take place, TAVI uses a minimally invasive method.
“A bioprosthetic heart valve is inserted through the artery in the groin and released in the heart where the original aortic valve is. The new heart valve then takes over the job and restore normal function,” explained Dr. Ong.
“In this case, the old native valve is not removed but TAVI treatment is such that the new valve is placed over it while the latter would be held to the side.” he added.
While the new valve is usually inserted through the groin, sometimes the minimally invasive procedure is done through an artery in the shoulder or a small cut in the chest through the aorta for those whose groin arteries are too small or unsuitable.
“I have a patient who was about 70 years old when she received the TAVI procedure. Her quality of life was severely impacted when I first saw her. She couldn’t go out as she always felt breathless,” Dr. Ong shared.
As compared to regular surgery where it requires a longer hospital stay, TAVI allows patients to get back to their normal routine without too much of a downtime.
With TAVI, patients are expected to have a prolonged lifespan even beyond 10 years; on the account that they are not impaired by any other diseases. Most importantly, one can expect a better quality of life.
However, Dr. Ong also highlighted that there is a certain life expectancy to this bioprosthetic valve as well.
“After about 8 to 10 years, there is a risk that the valve could degenerate. That’s when the patient would need to get another valve replacement (TAVI) to ensure their aortic valve continues its function,” he shared.
On this note, Dr. Ong emphasized that it is possible for relatively younger patients to opt for this procedure instead of the traditional open heart surgery where valve replacement is done. However, if they are expected to live for another 20-30 years, he would not recommend it.
“70 years old is the cut off age for me. For anyone younger than that, I’d still recommend them to go for the traditional surgery where the valve can be replaced with a biological heart valve replacement,” he added.
Of course, apart from the elderly where aortic stenosis is most prevalent in, there are also patients who are born with abnormal aortic valve where it degenerates quite early on in life. Similarly for this group, Dr. Ong would suggest the surgery route, unless there are other factors that puts these patients at high risk for surgery. However, with that said, Dr. Ong reminded that this treatment benefits the elderly patients most; especially those with comorbidities and are deemed not suitable for surgery.
In conclusion, TAVI presents as an alternative treatment option for those suffering from aortic valve stenosis who are elderly, or for younger patients who are not suitable for open heart surgery. It provides patients an option to prolong their lifespan and improve their quality of life.
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