Transcatheter Aortic Valve Replacement (TAVR)

Transcatheter Aortic Valve Replacement (TAVR)

Advances in Aortic Valve Repair, Replacement

The important of the aortic valve, one of four valves that regulate blood flow through the heart, cannot be overstated. The aortic valve, a one-way check valve, separates the heart’s main pumping chamber (left ventricle) from the main artery that supplies oxygen-rich blood to your body.

Like any movable part in an engine, the aortic valve can wear out over time.  The way it wears out is not unlike what happens when you walk around barefoot — you get callouses on the bottom of your feet. That’s the same type of change that happens to those valve leaflets and , as a consequence, they get less and less pliable. So the leaflets open less and less as time goes on. It’s sort like putting your thumb at the end of a garden hose. The amount of water coming out gets less and less, but the pressure inside the hose is enormous.  Because less water (blood) is coming out, and because the pressure inside the hose (heart) is high, there is a back-up behind and not enough going forward.  As a consequence, we feel tired earlier in the day, short of breath with less and less exertion, our ankles may swell.   This is not aging, this is congestive heart failure.

Aortic stenosis, which means the aortic valve has narrowed over time and results in restricted blood flow to the aorta, is not just a part of aging, but a serious condition which can affect middle-aged or younger adults.

Diagnosing Aortic Valve Stenosis

The many advances in replacing or repairing the aortic valve cannot be realized unless an individual is first diagnosed with aortic valve disease, which often involves stenosis, or narrowing. Regular checkups are a must. Often, patients are diagnosed their primary care doctor who hears a “heart murmur” through a stethoscope.

As the valve gets tighter and tighter, the blood comes out at a higher velocity. The increased velocity created with the hardening of the aortic valve is the murmur that a doctor hears when he or she listens to your chest, the ‘whooshing’ sound.

Your doctor will determine that the valve is getting tighter and that is what’s making you have that lack of energy.

Over the course of time, when the valve gets too narrow, it means not enough blood can get out of the heart and so it backs up into the rest of the system. It backs up into the lungs. That’s what is known as congestive heart failure. When you start to feel these symptoms, it may not be aging and it’s worth making an appointment to see your cardiologist.

Heart Murmur and Other Symptoms

Aortic stenosis produces symptoms, such as abnormal heart sound (heart murmur) that can be heard through a stethoscope (think back to the garden hose explanation…the high pressure coming out of the hose is  what cause the sound of the murmur); shortness of breath, particularly when you have been very active or when you lie down; dizziness; fainting, chest pain or tightness, or irregular heartbeat. Aortic valve disease can cause very serious complications, including heart failure, stroke and death.

Catheter Based Valve Surgery

Interventional cardiologists and surgeons perform this minimally invasive TAVR procedure as a team. For the right candidate, TAVR replaces a diseased aortic valve with a new, biocompatible valve. Following just a needlestick in the groin, physicians use a guide wire to move the new valve (collapsed and placed inside a catheter and wire mesh) through a vessel into the heart. We often expand a small balloon to open the diseased valve wider. They position the new valve inside and check its function using echocardiography. And what we do is crimp this down and it actually becomes very, very small. And that’s mounted on a stent and that’s brought all the way across the old heart valve. Once it gets to where we need it, we spring it into place. It goes inside the old valve and pushes it to the side and this then becomes the new valve, which opens and closes without any impedance at all.”