Overview of aortic valve disease

Aortic Valve Disease entails damage to, and dysfunction of, the aortic valve, one of the four valves in the heart. The most common valvular problem in old age is aortic valve disease. The aortic valve is one of four valves that control the flow of blood into and out of the heart. In particular, the aortic valve controls the flow of oxygenated blood pumped out of the heart from the left ventricle into the aorta, the main artery leading to the rest of the body.

Aortic valve disease symptoms vary and can be confused with the regular process of aging

Some patients have minimal symptoms, but valve disease is progressive and will eventually lead to heart failure if left alone.

Aortic valve disease symptoms include:

  • Shortness of breath
  • Chest pain
  • Irregular heartbeat
  • Fatigue
  • Swollen ankles/feet
  • Difficulty lying flat, needing multiple pillows or needing to sit up

Aortic valve conditions

The aortic valve is located between the left ventricle and the aorta. As the left ventricle contracts, it pumps blood out of the left ventricle through the aortic valve and into the aorta. The aortic valve consists of three leaflets, or flaps, that open to allow blood to flow from the ventricle to the aorta and close to prevent blood flow in the opposite direction.

Aortic Valve Stenosis
Aortic valve stenosis is a heart condition that occurs when there is an inadequate opening of the aortic valve that limits blood flow to the body. Degeneration and calcification of the valve with age can cause stenosis, but there are several other causes of aortic valve stenosis, including rheumatic fever, a congenital bicuspid aortic valve and radiation therapy.

Aortic Valve Regurgitation
Aortic valve regurgitation occurs when the aortic valve leaflets do not close properly and blood returns back to the heart. This kind of heart problem may be caused by an enlargement of the aortic root in aneurysms, by endocarditis or infection, rheumatic fever or injury.

Diagnosing aortic valve disease

The severity of the disease and symptoms helps determine aortic valve treatment

Evaluating aortic valve disease includes:

  • EKG
  • Echocardiogram (ultrasound of the heart)
  • Cardiac catheterization
  • CT scan with contrast. The CT scan provides information for patients considering a catheter procedure, like transcatheter aortic valve replacement (TAVR), who previously had heart surgery. It helps determine the suitability of the anatomy for the TAVR procedure and whether alternate access other than the femoral arteries would be required. Occasionally the CT scan is used to determine the severity of the stenosis by quantifying the calcium buildup on the valve.

Decisions on the right aortic valve treatment are based on discussions with our heart team, including a cardiologist, cardiac surgeon and the primary care physician. Patients with advanced heart failure may not be candidates for surgery and can consider treatment options directed at heart failure.

Aortic valve replacement

Aortic valve disease treatment involves an aortic valve replacement.

  • Surgical aortic valve replacement

    During surgical aortic valve replacement, the heart surgeon removes the aortic valve and the calcium build up and then replaces the aortic valve with a tissue or a mechanical prosthesis. Tissue valves need to be replaced every 10 years, while the mechanical valves can often last a lifetime. However, mechanical valves require blood thinners (Coumadin) for life following the aortic valve replacement surgery.

  • TAVR (Transcatheter aortic valve replacement)

    TAVR is a minimally invasive procedure and an alternative to traditional open-heart surgery for aortic stenosis for patients who are candidates. This approach avoids a sternotomy (the use of the heart-lung machine) and allows a quicker recovery that usually only takes days. TAVR is performed by a team of heart physicians, including a cardiologist and a cardiac surgeon. A catheter is threaded from the groin into the aorta and through the aortic valve. A tissue valve is then deployed in position, pushing the native diseased valve and calcium aside. TAVR was initially reserved for high-risk patients only who were not candidates for open surgery. As experience with TAVR increased and the results gained acceptance, its use expanded to include lower-risk patients and those deemed appropriate by the heart team.

What to expect during aortic valve surgery
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Preoperative

After an evaluation by the heart team and undergoing appropriate testing, you will meet our nurse educator who will give you a booklet and talk to you about the stepwise progression you will be expected to make through your heart surgery for aortic valve disease. Your medications will be discussed, and you may be asked to stop certain medications up to one week before the aortic valve surgery procedure. It is important to plan ahead and make arrangements for transportation to and from the hospital and also help at home after the procedure.

Day of aortic valve surgery

Aortic Valve Surgery: After arriving at the admitting area, heart patients are seen by the operating room team, including the anesthesia team that starts an intravenous line to give medications. The family will be asked to stay in the waiting area until the aortic valve replacement procedure is complete. Patients are placed on a ventilator for the duration of the surgery and a few hours after surgery. The surgery can last several hours depending on the complexity and on the findings in the operating room. After completion of the aortic valve surgery, the heart surgeon will speak to the family about the procedure and answer any questions, including how long recovery from the surgery might take.

TAVR: After arriving at the admitting area, patients are seen by the operating room team, including the anesthesia team who start an intravenous line to give medications. The family will be asked to stay in the waiting area until the procedure is complete. Most times, patients are sedated but still breathing on their own without the use of a ventilator for the duration of the TAVR procedure—which lasts about one hour. After the heart procedure, an echocardiogram confirms the result, and the heart surgeon or cardiologist will then update the patient’s family.

Postoperative

Aortic Valve Surgery: Patients are usually in the hospital for five to sevel days after aortic valve surgery. The stay in the ICU is usually for the first 24 hours, followed by a transfer to a monitored bed on the floor. Most patients begin walking the day after surgery.  Here at Baylor Scott & White – Temple, we have a large team of people who specialize in the various aspects of recovery to work with you, teach you and instruct you on the best practices for your recovery. Follow-up visits in the clinic are at two weeks and four weeks after the aortic valve surgery.

TAVR: Patients are admitted for observation and usually return home within 24–48 hours following the TAVR procedure. Most patients begin walking shortly after the procedure. Limitations include no heavy lifting (more than 10 lbs.) or driving for two to three weeks. Follow-up with the TAVR team is at 30 days and at one year.