Aortic Valve Disease Treatments
Aortic valve disease should be regularly monitored over time (serially monitored) by your physician, who will determine with you the best clinical course of action.
For low-to-moderate aortic valve stenosis, medications may provide symptomatic relief.
Once aortic valve disease becomes severe, surgical repair or replacement of the valve is the most effective treatment to avoid the onset of heart failure. Serial testing and physician counseling about physical activity patients may undertake and careful monitoring of symptoms may help determine the optimal time for surgery.
Symptomatic patients who have severe aortic stenosis or chronic, severe aortic regurgitation should undergo valve surgery.
If surgery is determined as necessary for symptomatic patients with aortic valve disease, physicians at the Center for Heart Valve Disease will perform a comprehensive analysis of each patient, including:
- Type of valve disease
- Heart function
- Patient lifestyle
- Coexisting medical conditions or problems
This analysis then becomes the framework by which the patient and the cardiac surgeon determine collaboratively what type of valve repair or valve replacement is ideal for their case.
Cardiac surgeons Patrick M. McCarthy, MD, Edwin C. McGee, MD, S. Chris Malaisrie, MD, and Hyde M. Russell, MD, have championed all of the current surgical techniques used to repair or replace the aortic valve.
Minimally Invasive Aortic Valve Replacement
Minimally invasive aortic valve replacement (AVR) offers excellent long-term results for patients, including:
- Less pain
- Earlier return to productivity
Transcatheter Aortic Valve Replacement
Transcatheter Aortic Valve Replacement (TAVR) is a treatment option for high-risk patients who are not candidates for open surgery. This procedure has been approved by the FDA and is now available for commercial use.
Researchers at the Center for Heart Valve Disease are investigating a transcatheter technique for implanting a prosthetic (artificial) valve inside stenotic aortic valves. This investigational trial -- the PARTNER II Trial: Placement of AoRtic TraNscathetER Valves -- is offered to participants who are considered at intermediate-to-high risk as an alternative to conventional AVR.
Aortic Valve Repair
Aortic valve disease is usually treated through either the repair of the damaged valve, or, if the damage is too severe, replacement.
Heart valve repair involves a surgical procedure during which the surgeon may need to trim, reshape or rebuild your diseased valve. During valve repair surgery, a ring is placed at the base of the heart valve to provide added support to the valve. This procedure is referred to as an annuloplasty.
Aortic valve repair may be performed in patients with aortic regurgitation. Unfortunately, valve repair in patients with aortic stenosis that involves leaflet decalcification (reversal of the hardening, or calcification, of heart valve leaflets) is not a feasible treatment option. It has been associated with early post-operative aortic regurgitation caused by the scarring of the valve leaflets, and may lead to a return to stenosis caused by recalcification. Patients will be required to take an anticoagulation (blood-thinning) medication for three months after surgery.
TRANSFORM (Sutureless Valve)
Edwards Lifesciences Corporation received approval from the US Food and Drug Administration (FDA) to begin a clinical trial of up to 650 patients who need their aortic valves replaced. The clinical trial, known as TRANSFORM, will evaluate the Edwards INTUITY valve system in patients who have calcific aortic stenosis or stenosis-insufficiency.
The valve was designed to decrease total operative time and allow for a less-invasive surgical approach.
Balloon Aortic Valvuloplasty
Balloon aortic valvuloplasty is a nonsurgical procedure performed to repair aortic stenosis using a balloon catheter inside the diseased valve.
The balloon is placed into the aortic valve and is then inflated in an effort to increase the opening size of the valve, thereby improving bloodflow. This is considered:
- As a "bridge" to surgery in patients with unstable bloodflow who are at high risk for aortic valve replacement
- Used for relief of symptoms in patients with other serious conditions that prevent performance of aortic valve replacement
Repair of Bicuspid Aortic Valve
Patients with bicuspid aortic valve (BAV) may have valve repair for leaky valves. BAV affects 1 to 2 percent of the general population and is one of the most common congenital heart disorders, arising during fetal development. It affects both the aortic valve and the thoracic aorta.
The Center for Heart Valve Disease offers cutting-edge diagnostic testing as well as medical and surgical treatment options for patients with BAV.
Often patients with aortic valve disease may experience aortic aneurysms, which, if enlarging beyond a certain diameter (typically >4.5 cm), may require repair.
After heart valve surgery, an echocardiogram (ECHO) is a non-invasive test used to evaluate your heart valves and heart function.
A pre-discharge ECHO is performed to establish a patient's clinical baseline after surgery.
Depending on your symptoms and progress after surgery, additional ECHO studies may be recommended by your cardiologist. Seeing your cardiologist yearly for a check-up will help to determine if additional testing is required.
If you have no symptoms, it is recommended that an ECHO be obtained three years after valve surgery, and then once a year after that.
Call your physician immediately if you experience any of the following symptoms:
- Chest pain
- Shortness of breath
- Excessive fatigue
- Unexplained fevers
Your ECHO should be scheduled with your local cardiologist. Please request that your physician faxes the report to Patrick M. McCarthy, MD, to the attention of Eileen McDonald, at 312-695-1903.
Antibiotics Prior to Dental Procedures
As a reminder, you should not have any dental procedures for 12 weeks after undergoing heart surgery.
You will need to take antibiotics before dental or surgical procedures. Before any minor surgical or dental procedures, always inform all of your healthcare providers that you have had heart valve surgery.
Good dental hygiene and routine dental check-ups are recommended.
It is important to keep all appointments for blood work, tests and physician exams. Your cardiologist will make future medication changes and provide refills as needed. Talk with your physician about cardiac rehabilitation or routine exercise programs. If you had a sternotomy, remember to avoid lifting 20 pounds or more of weight for 6 to 8 weeks after surgery.
To monitor the continued success of your recovery and postoperative progress, you will be contacted by our office 3 to 6 months after surgery. Feel free to contact us at any time with questions or concerns.
For more information regarding aortic valve disease and the treatments available, please contact the Bluhm Cardiovascular Institute at 1-866-662-8467 or request a first time appointment online.