It’s not normal to suddenly find yourself gasping for breath during activities you can usually handle. Sure, as we age, physical exertion becomes more challenging. However, this decline should be a gradual process. If you had no problem bringing your groceries into your home last week and suddenly find that same chore difficult today, you should see your doctor. A faulty heart valve might be making your heart work too hard.
A hardened aortic valve often leads to aortic stenosis – a narrowing of the aortic valve – that leads to the body’s largest artery that supplies it with oxygen-rich blood. More than 200,000 cases of aortic valve stenosis will be diagnosed in the United States this year. Valves are like doors with hinges that help blood move in the right direction throughout the body. However, sometimes those hinges become too loose, causing blood to leak back in the wrong direction.
More commonly, the hinges become “rusty,” according to Marc Bloom, MD, cardiovascular and thoracic surgeon and Chief of Cardiac Surgery at the AdventHealth Pepin Heart Institute. That’s when the valve doesn’t open all of the way.
The Dangers of Aortic Valve Stenosis
“The symptoms of aortic stenosis can be subtle,” says Dr. Bloom. “But it’s a dangerous disease and not one to be ignored.”
When the aortic valve becomes narrow enough, the heart makes up for this by pumping harder. Over time, the heart becomes thickened just like any other muscle. Blood that is normally squeezed out of the heart easily is now being pushed out like a pressure washer hose.
“The heart is supposed to look like a ballerina, not a linebacker,” says Dr. Bloom to illustrate how much aortic stenosis can build heart muscle – and not in a good way. That’s because when the heart muscle gets too thick, fluid can back up into the lungs and the patient may develop congestive heart failure.
Without treatment, aortic stenosis leads to rapid decline. Dr. Bloom likens its survival rate to that of advanced lung cancer. He says that by the time he sees most patients, they are experiencing shortness of breath from regular activities, and a few even have overt heart failure requiring them to be on oxygen. However, aortic valve stenosis is treatable, and patients generally have a good prognosis once they have their valves fixed.
Getting Back to Ballerina: Aortic Valve Repair & Replacement
“Aortic stenosis is a mechanical problem that requires a mechanical fix,” says Dr. Bloom. He offers heart surgery to replace the aortic valve so they function correctly once again. He also uses animal tissue valves – his preferred valve comes from a cow – to replace hardened heart valves beyond repair.
Traditionally, valves have been replaced through open heart surgery. While this approach is very safe today and still ideal for some patients, it involves a long recovery. Over the past decade, a new minimally invasive approach to valve replacement has emerged that requires only a small incision in the groin. This is called transcatheter aortic valve replacement, or TAVR. A catheter – a thin tube – is threaded through a blood vessel in the groin up to the heart. When it reaches the heart, the surgeon uses the instruments on the end of the catheter to open up and replace the valve.
When the FDA approved TAVR in 2011, it could only be used for patients for whom open surgery was not a possibility. These are patients who are so elderly, frail or sick that the surgery would have been too dangerous for them. However, the TAVR procedure works so well that it was tried for lower risk patients. Eventually, studies proved that the approach was just as good as open surgery, and, in 2019, TAVR became an option for patients regardless of their open surgery risk.
However, TAVR is not for everyone, particularly for younger patients. Because the procedure is still so new, it is not yet understood how long a TAVR valve replacement will last. Dr. Bloom says that tissue valves typically last about 15 to 20 years until they need to be replaced. TAVR can be used again to replace an aortic valve a second time, but it’s not known if a third aortic valve replacement would be possible.
Whether through TAVR or open surgery, once the aortic valve is working well again, the heart muscle thins back out as normal.
AdventHealth Pepin Heart Institute: A High-Volume Valve Repair Center in Tampa
The structural heart cardiac surgeons/cardiologists at the Pepin Heart Institute were the first in the Tampa area to offer TAVR nearly a decade ago, and they have the experience needed to perform this procedure well. For some patients, they work with an interventional cardiologist to offer what is called a hybrid procedure: where the cardiologist inserts a stent to open up a heart vessel and the team performs a TAVR operation. Our experienced team works together to ensure that our patients receive the ideal heart operation for each of their unique situations.
If you have a heart condition such as aortic stenosis that might require cardiac surgery, the AdventHealth Pepin Heart Institute can help. Call Call855-303-3627 to schedule an appointment with one of our highly experienced cardiovascular surgeons.