Introduction
There are many ways to treat patients with structural heart diseases. Transcatheter Aortic Valve Replacement (TAVR) and Surgical Aortic Valve Replacement (SAVR) are two different methods used to treat aortic stenosis, a condition in which the aortic valve becomes narrowed and doesn’t open properly. The aortic valves become calcified and stiff, making it difficult for the heart to pump enough blood effectively. The main function of the aortic valve is to open and close and allow blood to flow from the left ventricle of the heart to the aorta through which oxygen-rich blood is supplied to the rest of the body and the coronary arteries. This can increase the risk of heart failure, leave you feeling faint and dizzy, and cause chest pain, also known as angina. In such a case, aortic valve repair surgery, or what we know as aortic valve replacement, is often recommended for these heart patients. It is totally up to the doctor to determine the better option: open-chest surgical aortic valve replacement (SAVR) or minimally invasive transcatheter aortic valve replacement (TAVR), after a detailed consideration of all factors, including the patient’s preferences.

What is the difference between TAVR and SAVR?
TAVR is a minimally invasive, non-surgical procedure done through a small groin incision. A catheter is inserted through the incision and guided to the heart, where a replacement valve is deployed without the need to open the chest or the heart. TAVR is typically done on older patients or those who previously had a SAVR and are considered high-risk for traditional open-heart surgery, who are vulnerable to complications.

SAVR, on the other hand, is a traditional open-heart surgical procedure that has been in practice for over 50 years and involves making a large incision in the chest to access the heart. The damaged or diseased aortic valve is then replaced through the incision. SAVR is typically done on symptomatic patients who can tolerate open-heart surgery.

Which is better – TAVR or SAVR?
Both TAVR and SAVR have risks associated with them as well as similar outcomes in terms of survival and improvement in symptoms.

• In terms of longevity, both TAVR and SAVR have similar outcomes, with both valves lasting for about 10-15 years.
• Minimal invasive procedure: One of the main advantages of TAVR over SAVR is that it is a minimally invasive procedure, which means that the incision is much smaller and there is less pain and discomfort to the body.
• Better quality of life: As TAVR is done through a catheter rather than open-heart surgery, there is a lower risk of complications such as bleeding and infection.
• Latest Technology with lesser pain & faster recovery Another advantage of TAVR is that it is typically considered a safer option for high-risk patients, such as the elderly or those with other health conditions that make open-heart surgery risky. This is because TAVR is less invasive and carries a lower risk of complications.
• Shorter hospital stay & improvement in heart function: TAVR is associated with a shorter hospital stay and a faster recovery time when compared to SAVR. TAVR also has a lower risk of stroke in comparison to SAVR.

Also, the following factors decide which is the right procedure to choose between SAVR and TAVR,

• Size considerations – Your surgeon will consider the size of your aortic valve and blood vessels.
• Type of Aortic Disease – The type of aortic disease or condition also influences the surgeon’s choices.
• Co-morbidities – Pre-existing co-morbidities like diabetes, lung disease or a history of heart attack will heavily influence the surgeon in the choice of procedure.
• Cardiac issues and stroke risks – The choice of valve procedures is determined by the presence of certain cardiac conditions in patients. Like those with coronary artery diseases requiring surgical correction should opt for SAVR.
• Age and frailty – Physiological conditions like age and capacities in daily life like ability to function on their own, mobility, ability to move around and strength of grip also determine the choice of valve procedure.

Conclusion
It’s important to consult a cardiologist and/or cardiac surgeon for guidance on which procedure is best for you, as the best option will depend on the individual’s specific heart condition and overall health. This will involve exploring all the benefits, risks, advantages, and disadvantages as well. Both TAVR and SAVR have similar outcomes in terms of survival and improvement in symptoms, but each has unique advantages and disadvantages.

FAQs :

Q. What is the difference between TAVR and SAVR?
A. TAVR is a minimally invasive procedure that is done through a small incision in the groin. A catheter is inserted through the incision and guided to the heart, where a replacement valve is deployed. SAVR, on the other hand, is a traditional open-heart surgical procedure that involves making a large incision in the chest to access the heart. The aortic valve is then replaced through the incision.

Q. Who is a candidate for TAVR?
A. TAVR is typically done on patients who are considered high-risk for traditional open-heart surgery. This can include elderly patients or those with other health conditions such as lung disease, kidney disease, or a history of previous heart surgery.

Q. Who is a candidate for SAVR?
A. SAVR is typically done on younger patients and those who can tolerate open-heart surgery.

Q. How long does each procedure take?
A. TAVR typically takes about 2-4 hours, while SAVR can take 4-6 hours or longer.

Q. What is the recovery time for each procedure?
A. TAVR has a shorter recovery time than SAVR, with most patients able to return to normal activities within 1-2 weeks. SAVR has a longer recovery time, with most patients taking 4-6 weeks or longer to fully recover.

Q. What are the risks associated with TAVR and SAVR?
A. TAVR carries a risk of complications such as bleeding, infection, and valve-related complications. SAVR carries risks such as bleeding, infection, and blood clots, as well as the risks associated with any open-heart surgery.

Q. How long do the valves last?
A. Both TAVR and SAVR valves last for about 10-15 years.

Q. Which procedure is best for me?
A. The best procedure for you will depend on your specific condition and overall health. It is important to consult a cardiologist and/or cardiac surgeon for guidance on which procedure is best for you.

References :
https://www.medscape.com/viewarticle/946173
https://www.mainlinehealth.org/blog/savr-vs-tavr

Aortic stenosis (AS) is a severe and potentially life-threatening condition affecting millions worldwide. While the condition can develop slowly over time, it can quickly become a major health concern, if left untreated or caught late, AS can progress rapidly and cause massive organ damage, leading to congestive heart failure and death within weeks or even days. 

That is why knowing the causes and symptoms of AS is crucial to understand the severity of the condition and catching it early before it gets out of hand. So read on to learn more about this condition and how to protect yourself from its potentially life-ending consequences.

What is Aortic Stenosis?
Aortic stenosis (AS) is a medical condition affecting the aortic valve, which regulates blood flow from the heart to the body. It is caused when the aortic valve narrows, leading to restricted blood flow and increased pressure on the heart. This can cause your heart to work harder and strain against the walls of the blood vessels, resulting in fatigue and pain. When this happens, it can interfere with the normal blood flow out of the heart, cause heart damage, and result in a sudden catastrophic event known as a dissection. Dissection can prove to be fatal, leading to death.

Causes of Aortic Stenosis
There are a few causes of Aortic Stenosis. It can be hereditary and may run in families, increasing the risk of the condition. It is also more likely to occur in people aged 40-70 and above due to calcium buildup on the valve over time. Other causes include congenital heart defects, rheumatic fever and radiation therapy. Furthermore, medical conditions such as hypertension, Paget’s disease of the bone, heart failure, kidney disease, and autoimmune diseases can also increase the risk. Last but not least, smoking and untreated infections can also damage the heart valves and increase the risk of aortic stenosis. 

Diagnosing Aortic Stenosis
Aortic stenosis is typically detected during a cardiovascular examination, including an EKG and listening for heart murmurs with a stethoscope. Other detection methods include chest X-ray, angiography, cardiac CT scan, cardiac catheterization, and heart MRI.

How Severe is Aortic Stenosis?
Aortic stenosis progresses slowly over several years and can worsen with age and secondary health conditions, such as heart failure, high blood pressure, and diabetes. While aortic stenosis can be a severe condition, its severity depends on various factors, including the extent of valve narrowing and the patient’s age and overall health. The degree of severity can vary from mild to severe. However, as mentioned above, any level of aortic stenosis can lead to significant complications if left untreated.

• Heart Failure: One of the most serious complications of aortic stenosis is heart failure. It happens when the heart is unable to circulate an adequate amount of blood. The heart has to work harder to push blood through the narrow opening as the aortic valve becomes more obstructed. Over time, this can lead to a weakened heart muscle and an inability to pump blood to the rest of the body effectively. Symptoms of heart failure include swelling in the legs and feet, fatigue, shortness of breath, and an irregular heartbeat. Heart failure can sometimes be fatal, particularly if not diagnosed and treated promptly.
• Arrhythmia:Another potential complication of aortic stenosis is arrhythmia or an irregular heartbeat. This can occur because the heart exerts more effort than necessary to circulate blood through the obstructed valve. As a result, it can disrupt the heart’s normal electrical activity. Arrhythmia can lead to symptoms such as palpitations, dizziness, and fainting. While it can often be managed with medication or other treatments, it can also be a serious condition that requires close monitoring and intervention.
• Cardiac Arrest: Cardiac arrest is probably one of the most severe complications of aortic stenosis. Cardiac arrest occurs when the heart stops beating suddenly. In some cases, people with aortic stenosis may experience sudden cardiac arrest without warning signs or symptoms. However, in many cases, cardiac arrest can be preceded by symptoms such as chest pain, shortness of breath, dizziness, or fainting. Cardiac arrest is life-threatening if not treated immediately.

Prevention of Aortic Stenosis
AS caused by natural aging is not usually preventable. But one should continue to lead a healthy lifestyle which includes managing diet, exercise, sleep, weight, and being alert to limit the interference of any cardiovascular disease. In addition, there are a few ways you can protect yourself against the development of aortic stenosis. These include:

• Maintain a healthy weight throughout your life by eating a balanced diet and exercising regularly. This helps to keep your blood pressure under control and lowers your risk of cardiovascular disease.
• Maintain healthy heart health by not smoking and following a healthy lifestyle, including getting enough sleep, avoiding alcohol. 
• Maintain and protect your blood vessels from damage by staying hydrated, avoiding excessive salt and sugar intake, getting enough exercise, and staying away from excessive sun exposure.
• Aortic stenosis caused by bacterial infection is preventable if infections are treated on time with antibiotics and other medications.
• Aortic stenosis caused by chronic or inherited conditions is not always preventable. 
• Periodic monitoring of routine ECG and regular medical checkups.

Summary
AS is most commonly seen in older people, especially after age 65. In some rare instances, children can be born with a defect in the aortic valve that can cause stenosis. Unfortunately, many do not realize they have AS until the condition triggers symptoms such as Pain or tightness in the chest with activity (angina), feeling of dizziness or fainting during activity, tiredness (fatigue), shortness of breath (dyspnoea), irregular heartbeats (arrhythmia) or Heart palpitations, swelling in your legs or they detect it during a medical diagnosis. AS is a complicated problem hence speaking with your doctor at the earliest about AS risks, especially when you have symptoms, can bring in timely intervention. There are advances in surgical and catheter-based techniques that can help treat the cases of older people with multiple conditions that complicate care in their recovery process. Timely or early treatment will ensure a good prognosis. Of course, that needs to be backed by lifelong follow-up and care to lead an everyday life. If left untreated, it can cause severe repercussions. Most do not make it more than a few years without treatment. If treatment is delayed, the extent of Heart damage decides if a full/partial recovery is possible. 

FAQs

What is the leading cause of aortic stenosis?
Calcium buildup on the aortic valve that comes with aging and over time is the most common cause of Aortic stenosis, which makes the valve tissue stiff, narrow, and less flexible & hence restricts the blood flow from the Heart to the rest of the body.

How severe is aortic stenosis?
Those with severe Aortic stenosis develop symptoms with a survival rate as low as 50% at two years and 20% at five years without aortic valve replacement.

What are the signs and symptoms of aortic stenosis?
Symptoms of aortic stenosis can include chest pain, troubled breathing, dizziness, heart murmur, rapid or irregular heartbeat, difficulty walking short distances, swelling of ankles and feet, and difficulty sleeping.

What is the life expectancy with severe aortic stenosis?
Aortic stenosis can be dangerous, costly, and debilitating. Chances of survival without treatment for severe symptomatic aortic stenosis are as low as 50% at two years after symptom onset and 20% at five years.

References : 
https://my.clevelandclinic.org/health/diseases/23046-aortic-valve-stenosis
https://bestpractice.bmj.com/topics/en-us/325
https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/aortic-valve-stenosis
https://www.ncbi.nlm.nih.gov/books/NBK557628/
https://emedicine.medscape.com/article/150638-overview
https://www.webmd.com/heart-disease/aortic-valve-stenosis
https://medlineplus.gov/ency/article/000178.htm
https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/problem-aortic-valve-stenosis

What Is Aortic Stenosis?

Aortic stenosis is a condition in which the aortic valve in the heart becomes narrowed or blocked, making it difficult for blood to flow properly from the heart to the rest of the body. Therefore, the heart has to work harder to pump blood, leading to strain and potentially causing severe heart problems. These include heart failure and even sudden cardiac arrest. 

Symptoms of Aortic Stenosis

The symptoms of aortic stenosis can vary, and they may not always be noticeable. In the early stages, people may not experience any symptoms at all. However, as the condition progresses, the symptoms become more noticeable and can lead to significant health problems. Let us take a look at the symptoms of aortic stenosis.

 
Chest pain: 
One of the most common symptoms of aortic stenosis is chest pain. The pain may be described as pressure or tightness in the lungs or the chest. It can occur during physical activity or even while resting. 

 
Shortness of breath: 
Shortness of breath can occur during physical activity or even while resting. People with aortic stenosis may feel like they are running out of breath, especially when they are not exerting themselves. As the condition progresses, the heart may struggle to pump enough blood to fulfill the body’s requirements, causing a feeling of breathlessness.

 
Dizziness and fainting: 
Dizziness and fainting are severe symptoms of aortic stenosis. They can occur due to a highly decreased blood flow to the brain, resulting in dizziness and loss of consciousness. Fainting indicates that aortic stenosis is advanced and requires immediate medical attention.
Fatigue:
Fatigue is another common symptom of aortic stenosis. It can be caused by the heart’s inability to pump the required blood to meet the body’s energy needs. As a result, people with aortic stenosis may feel tired or weak even after getting enough sleep.

 
Heart Palpitations:
Heart palpitation, rapid or irregular heartbeat, can feel like the heart is skipping a beat, fluttering, or racing. In people suffering from aortic stenosis, palpitations can occur due to the heart working harder to compensate for the narrowed valve. This can cause an irregular heartbeat, also known as an arrhythmia, leading to palpitations. 

Reduced Hunger And Body Weight:
These are less common symptoms of aortic stenosis but can occur in some patients. These symptoms are typically seen in severe cases of aortic stenosis, where the reduced blood flow can impact the digestive system and cause a loss of appetite. Additionally, the increased workload on the heart can result in the body burning more calories than usual, leading to unintentional weight loss. While reduced hunger and weight loss can indicate aortic stenosis, they are not specific to this condition. Other underlying health issues can also cause them. 

Recognizing the symptoms of aortic stenosis is important because early detection and treatment can significantly improve outcomes. In addition, aortic stenosis is a progressive condition, which means it will worsen over time if left untreated. By recognizing the symptoms of aortic stenosis early, patients can receive prompt medical attention and begin treatment to slow down the progression of the disease.

In severe cases, aortic valve replacement surgery may be necessary. Early detection can improve the chances of a successful outcome. Therefore, recognizing the symptoms of aortic stenosis is crucial for ensuring and improving the quality of life for those with this condition.

The severity and progression of symptoms can vary depending on the underlying cause of aortic stenosis. Understanding the causes of aortic stenosis can help patients, and their healthcare providers determine the best treatment and management.

Underlying Causes of Aortic Stenosis

Aortic stenosis is commonly caused by age-related wear and tear of the aortic valve or calcium buildup on the aortic valve. However, there are other causes of aortic stenosis, including congenital and acquired forms.

Congenital aortic stenosis is a condition that is present from birth. It occurs when the aortic valve is not formed correctly during foetal development.

Acquired aortic stenosis, on the other hand, is the most common cause of aortic stenosis. It occurs later in life due to other factors, such as calcium deposits on the aortic valve, which can lead to the narrowing and hardening of the valve.

Diagnostic Tests and Treatment Options

If aortic stenosis is suspected, the doctor will perform a physical exam and may order diagnostic tests like an Echocardiogram, Chest X-ray, CT scan, Stress test, or Cardiac MRI to confirm the diagnosis.

Treatment options for aortic stenosis depend on the severity of the condition. In some mild cases, medication may be prescribed, and lifestyle changes, such as maintaining a healthy weight, getting regular exercise, and quitting smoking, would be recommended to manage symptoms and prevent complications.

While in other severe cases, surgery may be necessary to repair or replace the aortic valve. Aortic valve surgery is an effective treatment option for aortic stenosis. Some of the treatment options are:
 
Balloon valvuloplasty: 
Balloon valvuloplasty involves inserting a catheter with a balloon on the tip into the narrowed aortic valve. This balloon is then inflated to widen the valve and improve blood flow.

Surgical aortic valve replacement:
This procedure involves replacing the damaged aortic valve with a mechanical or biological valve. During the surgery, the chest is opened, and the damaged valve is removed and replaced with a new valve.
 
Transcatheter Aortic Valve Implantation (TAVI) Or Transcatheter Aortic Valve Replacement (TAVR): 
TAVR is minimally invasive, and it involves inserting a catheter with a new valve on the tip through a small incision in the groin or the chest area. The catheter is guided to the damaged aortic valve, and the new valve is then implanted, replacing the damaged valve. TAVI or TAVR is a less invasive option than surgical aortic valve replacement. It may be suitable for patients who are not candidates for surgery.

Conclusion

Aortic stenosis is a severe heart condition that requires prompt medical attention. It can lead to significant health problems if left untreated. Therefore, it is important to recognize the symptoms of aortic stenosis for early detection and treatment. While the symptoms of aortic stenosis can be frightening, the good news is that effective treatment options can help manage symptoms and prevent complications. As a result, people with aortic stenosis can lead healthy, fulfilling lives with the right diagnosis and treatment.

FAQs

Q. What is aortic stenosis?
A. Aortic stenosis is a heart condition that occurs when the aortic valve, which regulates blood flow out of the heart, becomes narrowed or blocked. This can make it difficult for blood to flow properly throughout the body.

Q. What are the symptoms of aortic stenosis?
A. The most common symptoms of aortic stenosis include chest pain, shortness of breath, dizziness, fainting, fatigue, and heart palpitations. These symptoms can indicate that the heart is not functioning correctly, and it is essential to seek medical attention immediately.

Q. What causes aortic stenosis?
A. Age-related wear and tear on the aortic valve, and calcium buildup on the aortic valve are the common causes of aortic stenosis. However, congenital heart defects and other medical conditions, such as rheumatic fever, can also lead to the development of aortic stenosis.

Q. How is aortic stenosis diagnosed?
A. Aortic stenosis can be diagnosed by your healthcare provider through physical examination or using a variety of diagnostic tests like an Echocardiogram, Chest X-ray, CT scan, Stress test, or Cardiac MRI. These tests allow doctors to evaluate the heart’s function and determine the severity of the condition.

Q: How can aortic stenosis be prevented?
A: While aortic stenosis cannot be prevented entirely, some measures can be adopted to reduce the risk of developing the condition. These include exercising regularly, maintaining a healthy weight, quitting smoking, and managing high blood pressure and cholesterol levels.

Q. What are the treatment options for aortic stenosis?
A. Treatment for aortic stenosis depends on the severity of the condition. In mild cases, the symptoms may be managed by medication. Surgery becomes necessary in more severe cases requiring repair or replacement of the aortic valve. Aortic valve surgery is an effective treatment option that can improve the quality of life for people with aortic stenosis.

When it comes to ailments of the heart, Aortic Stenosis (AS) is one of the most common diseases, especially when it comes to senior citizens. It occurs when the opening of the aortic valve gets narrowed. Through the right intervention, Aortic Stenosis can be tackled. But to do so, one needs to know what the ailment entails. 

As mentioned, Aortic Stenosis is a disease that is more likely to occur among the elderly. That is why, on the eve of Senior Citizens Day, Dr. Karun Behal (MD, DM – Cardiology), Senior Consultant – Cardiology, Fortis Mohali, held a live session online where the specialist shared some vital insights on the ailment and various interventions that can be used to surpass it. Read on to know these key pointers from the live session. 

To start with, what is Aortic Stenosis?

In aortic stenosis, the Aortic valve doesn’t open completely, restricting the blood flow from the left ventricle of the heart to the aorta and the rest of the body. It may also affect the pressure in the left atrium. 

The aortic valve has three leaflets, and it separates the aorta from the left ventricle. The main function of the aortic valve is to open and allow blood flow from the left ventricle of the heart to the aorta, through which blood flows to the rest of the body. It also prevents the backflow of blood from the aorta to the left ventricle. Aortic stenosis happens when the valve doesn’t open up completely, which in turn reduces or blocks the blood flow. Dr. Behal also mentioned that aortic stenosis is more prevalent in the elderly population.

How is Aortic Stenosis diagnosed?

Dr. Behal opined that to treat this condition, it is important to determine if the symptoms are mild, moderate, or severe. Depending on the severity of the condition, the right treatment method is suggested. 

Aortic stenosis can be diagnosed clinically, where your doctor will use a stethoscope to look out for heart murmurs that may suggest an aortic valve condition. The doctor may also run several tests such as Echocardiography, which uses sound waves to create images of your heart. Echocardiography can also show the doctor how blood flows through the heart valves, and if there is an interference in the blood flow. 

What are the symptoms of Aortic Stenosis that one needs to look out for?

Most cases of aortic stenosis are asymptomatic, or the symptoms are visible only during the later stages. Some of the most common symptoms of aortic stenosis are:

• Heaviness/pain in the chest while indulging in physical activities
• Shortness of breath
• Fatigue
• Dizziness
• Palpitations

If these above-mentioned symptoms are persistent, it is important to talk to your medical practitioner immediately to diagnose aortic stenosis.

How is Aortic Stenosis treated?

Initially, aortic stenosis was treated through medications such as pain killers, blood thinners, and medicines that kept cholesterol levels and blood pressure in check, but it did not work on people with severe aortic stenosis. But nowadays, with the advancements in the medical field, severe aortic stenosis can be treated. Some of the most common treatment methods for aortic stenosis are:

Surgical Aortic Valve Replacement (SAVR): Surgery is one of the most popular methods to treat aortic stenosis. This is usually done through an incision in the chest. People who have undergone surgery for aortic stenosis have a better survival rate. However, surgery may not be recommended to elderly patients with aortic stenosis as it may lead to several health complications.

Transcatheter Aortic Valve Replacement (TAVR): This is a less invasive procedure for those who are at a higher risk of complications from surgical aortic valve replacement. In this procedure, the damaged valve is replaced with a bioprosthetic valve. 

What are the advantages of TAVR?

TAVR is a huge advancement in the field of medical sciences in the past 15-20 years. Due to its less invasive nature, TAVR has replaced open-heart surgeries. At first, TAVR was recommended to only those patients who were unfit for surgery. An open heart surgery involves attaching a heart-lung bypass machine to the patient and opening the chest cavity, which may lead to several complications. Post-surgery, the patient would have to be under observation for 10-12 days, and the recovery would take about 1 – 2 months. 

However, with TAVR, the chances of complications are reduced, and the patient can be discharged within 2-3 days of the procedure. The rate of recovery is also faster compared to SAVR.  However, SAVR is cost-efficient in comparison to TAVR.

Many patients and caregivers who had joined in on the session had questions for Dr. Behal, especially on the long-term consequences of the ailment. Here are a few of them. 

Can Aortic Stenosis cause sudden death?

Yes, aortic stenosis can cause sudden death, as the symptoms are not visible in the earlier stages. The patients do not recognize the signs until the later stages, during which treatment might be difficult, which may lead to sudden heart failure. The patients need to be mindful of the early signs and approach the doctor immediately to run diagnostic tests.

Does mild Aortic Stenosis require surgery?

No. SAVR and TAVR are recommended for those who are diagnosed with severe aortic stenosis. Mild and moderate symptoms can be treated with medications. However, the patient must frequently follow up with the medical practitioner to ensure that the symptoms do not worsen.

How long does a TAVI valve last?

In SAVR, two different types of valves are used – biological valves and prosthetic valves. Biological valves are made of animal tissues and last for about 10-15 years, while prosthetic valves are made of metal and last for about 20-25 years.

In TAVR, biological valves are used, and they last for 10-15 years.

What is the survival rate in Aortic Stenosis patients?

Aortic stenosis can either be asymptomatic or symptomatic. If the patient is asymptomatic and responds well to stress tests and other diagnostic tests, the outlook is positive, almost equivalent to the normal healthy adult population.

However, if the symptoms are severe, the outlook is negative. At this stage, it is important to run tests such as echocardiography to determine the damage done to the valve, and the treatment must be administered immediately.

What is the minimum age to undergo TAVI?

Initially, people above the age of 65 – 70 are considered for TAVI. And it is advisable for everyone above 75 to only opt for TAVR as the procedure is less invasive.

Does TAVR have any side effects?

Though TAVR is less invasive as compared to SAVR, there are several risks and complications associated with the procedure:

• Internal bleeding
• Pain
• Stroke
• Arrhythmia, requiring pacemaker implantation
• Death

Who qualifies for the TAVR procedure?

TAVR is mostly recommended to patients who display severe symptoms. After being diagnosed with aortic stenosis, it is necessary to discuss with your heart surgeon about the advantages and disadvantages of SAVR and TAVR, to decide the right treatment method for you. Sometimes, TAVR is also recommended for patients with moderate symptoms.

While diseases like Aortic Stenosis are indeed common, leading a healthy lifestyle & timely intervention by your doctor can help go a long way in keeping the disease at bay!

There has been news of hope in recent years for the treatment of a common heart condition Aortic Stenosis, a procedure called transcatheter aortic valve replacement (TAVR). It was introduced in the mid-2000s since then as many as 400,000 patients across the world have had TAVR. According to the trials published in 2010, it was found that the TAVR procedure drastically reduced the risk of death among the inoperable patients. TAVR has been also found to be effective for patients with high and intermediate risk of serious complications from surgery or death. Whether or not you should undergo the procedure is entirely your doctor’s call, but even then, it is essential you know all that you can about the procedure.

What is TAVR used for? 

TAVR is designed to treat Aortic stenosis hence it is important to understand the condition. 

Aortic valve stenosis or aortic stenosis occurs due to narrowing of the aortic valve opening. It is one of the most common and serious valves disease problems. Aortic stenosis restricts the blood flow from the left ventricle to the aorta and also affects the pressure within the left atrium of the heart. Some people have stenosis due to a congenital heart defect called a bicuspid semilunar valve. During aging, this condition is developed commonly as calcium or scarring damages the valve and restricts the amount of blood flowing through.

Sometimes the left ventricle wall may show muscular thickening because the ventricle must have worked hard to pump blood through the narrow valve opening into the aorta. Appropriate treatment can help reverse or help slow down the progress of this disease.

Symptoms caused by Aortic Stenosis

Many people may not experience any symptoms until the amount of restricted blood flow becomes greatly reduced. Then the symptoms may include:

• Chest pain

• Difficulty in walking short distances

• Feeling dizzy or light-headed or even fainting

• Rapid, fluttering heartbeat

• Difficulty in sleeping or needing to sleep in the sitting posture

• Swollen ankles or feet

• Decline in energy levels 

It may be important that someone suffering from aortic stenosis may not experience any of these symptoms. But if you observe a decline in routine physical activities or significant fatigue, it’s worth a doctor’s visit to check for reduced heart function.

Treatment for aortic stenosis

Your doctor may suggest a couple of tests to confirm or rule out aortic stenosis. Tests also help determine the cause and severity of the condition.

The treatment of aortic stenosis depends upon how severe your condition is. For mild or moderate cases your doctor may keep a check on you. You will have to get regular check-ups and echocardiograms. Your doctor may encourage you to make changes to improve your overall health. It might include:

• Working on weight loss

• Switching to a healthier diet

• Managing your stress

• Quitting smoking

• Exercising, depending on your symptoms

For patients with severe stenosis, treatment options may include surgical semilunar valve replacement (SAVR) or transcatheter semilunar valve replacement (TAVR).

Surgical Aortic valve replacement (SAVR) or transcatheter Aortic valve replacement

Traditional treatment of Aortic stenosis- Open Heart Surgery 

Open heart surgery is considered a major operation. During an open-heart SAVR procedure, an incision is formed within the chest to access the heart during which the heart is stopped and blood is bypassed through a heart-lung machine. After which the diseased valve is removed and replaced with a replacement valve. SAVR has been the historical standard treatment for aortic stenosis for years.

For candidates who are suitable SAVR has given good outcomes to those patients. But the major drawback of SAVR is the long recovery period that generally requires five to seven days of hospitalization after surgery and more than six weeks for a full recovery. If the patient has too many medical conditions then it makes them unsuitable for SAVR. 

A non-surgical treatment- TAVR

TAVR is a minimally invasive procedure. For severe aortic stenosis patients who cannot withstand open-heart surgery, it is now the first line of therapy. Unlike a SAVR procedure which involves opening the chest to exchange a patient’s semilunar valve with a mechanical or tissue valve, the TAVR approach delivers a collapsible replacement valve via catheter. This process involves inserting a hollow tube (catheter) into your aortic valve through the blood vessels. Once the new valve is placed, the balloon on the catheter’s tip is inflated to park the valve in the desired position. Once it’s done, the catheter is then removed and the new valve now does the job of regulating the blood flow.Patients who go under TAVR recover quicker compared to SAVR patients which allows them to leave the hospital and start cardiac rehabilitation sooner and that can help improve the quality of life. It is performed under sedative medication without giving general anesthesia and in most cases, the procedure takes 90 minutes. 

The risks TAVR may present

TAVR has major benefits but it also has certain risks as it is a complicated procedure. The risks may include stroke, heart attack, bleeding, and the need for emergency surgery. The risks are low but there is also potential damage to the electrical system of the heart which may result in the need for the placement of a permanent pacemaker. 

 Is TAVR right for everyone? 

Although it might seem like an obvious choice compared to the stress of open-heart surgery, a detailed review must come first because not everyone needs to undergo a TAVR procedure. All patients with severe aortic stenosis must be carefully evaluated to make the best choice for them. Patients in the high-risk category are usually likely candidates of TAVR. A potential patient must have severe aortic stenosis and a three-leaflet valve versus a two-leaflet valve. Patients who have an infection of the heart or associated aneurysms are also not advised for TAVR.

SAVR remains the preferred method for many patients, the surgical techniques have evolved and the valve technology has proven durability. Both the valves are tissue valves, the SAVR valve may be a fixed stent with an approximate lifetime of 15 years while as per The University of Texas Southwestern Medical Center TAVR valve which expands and contracts also has a lifespan of around 10 to 15 years.

If you think you have aortic stenosis, visit your doctor as soon as possible to minimize risks. Take a family member along with you for support and discuss all the options with your doctor. It is important to be evaluated by a heart team, which includes a clinical cardiologist, interventional cardiologist, and a cardiac surgeon. The team will review all your medical information and will provide you the treatment option that’s best for you along with the risks and benefits of the option.