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Treatment Options

Treatment for aortic stenosis depends on how far your disease has progressed. If your stenosis is mild, medication may be prescribed to help regulate your heartbeat and prevent blood clots. However, as the severity of your stenosis progresses, your doctor may recommend replacing the diseased aortic valve.

Severe aortic stenosis cannot be treated with medication. The only effective treatment is to replace your aortic valve.

Today there are 2 options to replace diseased aortic valves:

Surgical Aortic Valve Replacement (AVR)

1. Surgical aortic valve replacement (AVR)
Aortic Valve Replacement (AVR) through open heart surgery is a common treatment for severe aortic stenosis.  Surgical AVR has been performed for many years on patients who can undergo surgery and has lengthened patients' lives.

Surgical AVR is an open heart procedure. During surgical AVR, the surgeon removes the diseased aortic valve and replaces it with either a mechanical valve (made from man-made materials) or a biological valve (made from animal or human tissue).

Aortic valve replacement can also be performed through minimal incision valve surgery (MIVS). In MIVS, the surgeon can replace the diseased valve through a smaller incision while looking directly at the heart or through a small, tube-shaped camera.  MIVS may be an option for some patients.

Please consult your Cardiothoracic Surgeon for more information on surgical aortic valve replacement and its associated risks.

To learn more information about AVR or MIVS, click here.

Transcatheter Aortic Valve Replacement (TAVR)

2. Transcatheter aortic valve replacement (TAVR)
For people who have been diagnosed with severe aortic stenosis and who are high-risk or too sick for open heart surgery, transcatheter aortic valve replacement (TAVR) may be an alternative, and results in lengthening patients’ lives.

This less invasive procedure allows a new valve to be inserted within your native, diseased aortic valve. The TAVR procedure can be delivered through multiple approaches, transfemoral (through the leg), transapical (in the chest between the ribs), and transaortic (in the upper chest). Only a Heart Team (Interventional Cardiologist & Cardiothoracic Surgeon) can decide which approach is best for you based on your medical condition and other factors.

Please consult a TAVR Heart Team for more information on TAVR and its associated risks.

To see associated risks with TAVR, click here.

 

Please talk to a TAVR Heart Team (Interventional Cardiologist & Cardiothoracic Surgeon) about which treatment is right for you.

Medication
If you are diagnosed with heart valve disease, medication may be prescribed by your cardiologist to help relieve symptoms.  However, no medication exists for curing severe aortic stenosis.

Although helpful in managing some symptoms, medications cannot reverse damage to your heart valve. In some cases the damage continues to progress even with medications, and further action must be taken. Talk with your cardiologist about your options.

Balloon Aortic Valvuloplasty (BAV)
Balloon aortic valvuloplasty may relieve symptoms associated with severe aortic stenosis.  However, balloon valvuloplasty is not a lasting solution, as the valve tends to narrow again.  BAV is the repair of a stenotic aortic valve using a balloon catheter inside the valve. The balloon is placed into the aortic valve that has become stiff from calcium buildup. The balloon is then inflated in an effort to increase the opening size of the valve and improve blood flow.

 

Doctor discussion guide

Aortic Valve Replacement Options

Aortic Valve Replacement Option

TAVR can be performed through multiple approaches. For patients who are at high-risk or too sick for surgical AVR, TAVR may be an alternative.

Please remember, this information is not meant to tell you everything you need to know about your treatment options for aortic stenosis. Please talk to a TAVR Heart Team for more information.

The Heart Team Approach
When you are referred for treatment of aortic stenosis, it's important to have a full team composed of several medical specializations engaged in your care. This combines the expertise of collaborative Heart Teams that include Interventional Cardiologists, Cardiothoracic Surgeons, Echocardiographers, Anesthesiologists, and/or cardiac cath lab staff.

If you go to a TAVR center, a dedicated TAVR Heart Team will conduct a thorough evaluation to determine whether you are an appropriate TAVR candidate.

Make the most of your doctor visit
Your doctor plays a crucial role in diagnosis and can provide valued advice during treatment decisions. You may have questions and concerns about your condition and treatment options.  It can be hard to organize and remember your questions before and during your doctor visit. The Doctor Discussion Guide can help guide you.

Doctor discussion guide

The TAVR Procedure

Transcatheter aortic valve replacement (TAVR)
If your Heart Team determines that you are at high-risk or too sick for open heart surgery, transcatheter aortic valve replacement (TAVR) may be an alternative. This less invasive procedure allows a new valve to be inserted within your diseased aortic valve.

TAVR can be performed through multiple approaches, transfemoral (in the leg), transapical (in the chest between the ribs) and transaortic (in the upper chest).

Transfemoral (In the Leg) Approach Overview

In the transfemoral approach, an incision is made in the leg. 

Transfemoral approach procedure
Transfemoral Procedure

1. You will be placed under anesthesia. 

2. An incision will be made in your leg (or slightly higher up), where your doctor will insert a sheath (a short hollow tube). 

3. Your doctor will take a balloon and put it through the sheath to reach your aortic valve. The balloon will be inflated with fluid to break open your narrowed valve, deflated, and then removed. 

4. The Edwards SAPIEN XT transcatheter heart valve will be placed on the delivery system (long tube with a balloon on the end), and compressed on the balloon to make it small enough to fit through the sheath. It will be about the width of a pencil. 

5. The Edwards SAPIEN XT transcatheter heart valve will be placed on the delivery system (long tube with a balloon on the end), and compressed on the balloon to make it small enough to fit through the sheath. It will be about the width of a pencil. 

6. The balloon of the delivery system carrying the valve will be inflated with fluid, expanding this new valve within your diseased valve. During valve expansion, the heart is stabilized by temporarily speeding up the heartbeat. The new valve will push the leaflets of your diseased valve aside. The frame of the new valve is very strong and it will use the leaflets of your diseased valve to secure in place. Next, the balloon will be deflated.


7. Your doctor will make sure that your new valve is working properly before removing the delivery system and closing the incision in your leg. 



Watch the TAVR Procedure
(Transfemoral Approach)

This animated video shows an anatomical overview of what happens during the transfemoral approach, which is performed through an incision in your leg.

In the transapical approach, an incision is made in your chest between your ribs to access the apex (lowest part) of your heart. - See more at: http://184.106.136.94/treatment-options#sthash.wyydLm0g.HafWNd1M.dpuf





Transapical (In Your Chest Between the Ribs) Approach Overview

In the transapical approach, an incision is made in your chest between your ribs to access the apex (lowest part) of your heart.

 

Transapical approach procedure
Transapical procedure

1. You will be placed under anesthesia. 

2. An incision will be made in your chest between your ribs to access the apex (the lowest part) of your heart. Your doctor will insert a sheath (a short hollow tube) through the apex and into the left ventricle.

3. Your doctor will take a balloon and put it through the sheath to reach your aortic valve. The balloon will be inflated with fluid to break open your narrowed valve, deflated, and then removed. 

4. The Edwards SAPIEN XT transcatheter heart valve will be placed on the delivery system (long tube with a balloon on the end), and compressed on the balloon to make it small enough to fit through the sheath. It will be about the width of a pencil.

5. The delivery system carrying the valve will be placed through the sheath and delivered up to the aortic valve, guided by a type of X-ray. 

6. The balloon of the delivery system carrying the valve will be inflated with fluid, expanding this new valve within your diseased valve. During valve expansion, the heart is stabilized by temporarily speeding up the heartbeat. The new valve will push the leaflets of your diseased valve aside. The frame of the new valve is very strong and it will use the leaflets of your diseased valve to secure in place. Next, the balloon will be deflated. 

7. Your doctor will make sure that your new valve is working properly before removing the delivery system and closing the chest incision between your ribs.






Watch the TAVR Procedure
(Transapical Approach
)
This animated video shows an anatomical overview of what happens during the transapical approach, which is performed through an incision in your chest between your ribs.

Transaortic (In the Upper Chest) Approach Overview

In the transaortic approach, an incision is made in the upper chest.

Transaorticl approach procedure

1. You will be placed under anesthesia. 

2. A small incision will be made in your upper chest, where your doctor will insert a sheath (a short hollow tube). 

3. Your doctor will take a balloon and put it through the sheath to reach your aortic valve. The balloon will be inflated with fluid to break open your narrowed valve, deflated, and then removed. 

4. The Edwards SAPIEN XT transcatheter heart valve will be placed on the delivery system (long tube with a balloon on the end), and compressed on the balloon to make it small enough to fit through the sheath. It will be about the width of a pencil. 

5. The delivery system carrying the valve will be placed through the sheath and delivered up to the aortic valve, guided by a type of X-ray. 

6. The balloon of the delivery system carrying the valve will be inflated with fluid, expanding this new valve within your diseased valve. During valve expansion, the heart is stabilized by temporarily speeding up the heartbeat. The new valve will push the leaflets of your diseased valve aside. The frame of the new valve is very strong and it will use the leaflets of your diseased valve to secure in place. Next, the balloon will be deflated. 

7. Your doctor will make sure that your new valve is working properly before removing the delivery system and closing the front of your chest. 





Watch the TAVR Procedure
(Transaortic Approach)

This animated video shows an anatomical overview of what happens during the transaortic approach, which is performed through an incision in the upper chest.


Your TAVR Heart Team will recommend a treatment option for you based on your overall health.


Aortic Stenosis and TAVR Brochure

Download the TAVR Patient Guide
Click the button below to download an informative brochure that goes into detail about aortic stenosis and the TAVR procedure.



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