What is aortic stenosis?²

Aortic stenosis is a serious condition that impacts the heart health of millions of people each year. This progressive condition is caused by a narrowing of the aortic valve, which prevents normal blood flow. Because the condition gets worse with time, doctors will measure it as mild, moderate, or severe (depending on how damaged the valve is).

What causes aortic stenosis?

There are 4 main causes of aortic stenosis: calcium buildup on the valve leaflets, birth defects that may impact the structure of the aortic valve, rheumatic fever which can cause scar tissue to form in the heart, and radiation therapy.³

What is severe aortic stenosis?

If aortic stenosis goes untreated, it will progress to the severe stages of the disease. Severe aortic stenosis means the aortic valve has a severe build-up of calcium and has a difficult time opening and closing. Your heart may need to work harder to pump blood throughout your body.

What is severe symptomatic aortic stenosis?⁴

Once aortic stenosis advances to the severe stage, it can be life-threatening so it's important not to delay treatment. As the leaflets become more damaged, the opening of the aortic valve becomes more narrowed and your heart muscle gets weaker. Uncomfortable symptoms such as shortness of breath or fatigue may become more noticeable and can become life-threatening. This is called symptomatic severe aortic stenosis. It is important to tell your doctor right away if you experience symptoms or if your symptoms worsen.

What are the symptoms of severe aortic stenosis?²

Symptoms of severe aortic stenosis include shortness of breath, chest pain, fatigue, lightheadedness, rapid or irregular heartbeat, swollen ankles/feet or difficulty exercising. These symptoms may indicate your aortic stenosis has progressed to a life-threatening point.

How serious is severe aortic stenosis?

Up to 50% of people who develop severe aortic stenosis (with symptoms) have an average life expectancy of 2 years if their aortic valve is not replaced.⁴ If you've been told you have severe aortic stenosis, don't wait to ask your doctor about getting treated.

Is aortic stenosis different if you have a bicuspid aortic valve?

No. The only difference is the number of leaflets the aortic valve has. Aortic stenosis is the stiffening of your aortic valve (regardless if you have two or three leaflets), which causes a narrowing of the aortic valve opening. This means the valve cannot fully open and close like it should. The amount of blood pumped with each beat of your heart is reduced, so it’s forced to work harder to supply your body with the blood it needs.

How is aortic stenosis diagnosed?⁵

Your doctor will perform a few tests to determine if you have aortic stenosis. This is initially done by listening to the sounds of your heart with a stethoscope. Diagnosis may also be done through a test called an echocardiogram, which uses ultrasound waves to obtain images of the heart chambers and valves.

What are the treatment options for aortic stenosis?

Depending on how far your aortic stenosis has progressed, your doctor may prescribe medication to help control your symptoms. But it is important to remember: the disease cannot be fixed with medication alone⁶ and will continue to get worse until you treat it. This can be done through transcatheter aortic valve implantation (TAVI) or open heart surgery.

What treatment options are available for severe aortic stenosis if you have a bicuspid aortic valve?

Both TAVI and open heart surgery may be treatment options for bicuspid patients. However, only a Heart Team can determine which treatment option is best for the patient. Those with bicuspid severe aortic stenosis should seek an evalutation with a Heart Team to discuss treatment options available for them.

What is TAVI (Transcatheter Aortic Valve Implantation)?

TAVI (also known as transcatheter aortic valve implantation or TAVI for short) is a less invasive^7,8 procedure for replacing a diseased aortic valve. During the procedure, your doctor will use a catheter to implant a new valve within your diseased valve. TAVI can be performed through multiple approaches; however, the most common is through a small incision in the leg. TAVI procedures can be performed under conscious sedation, rather than general anesthesia.⁹

What are the different approaches used to perform TAVI?

TAVIR can be performed in different ways depending on each individual’s anatomy.

Some approaches include:

• The transfemoral approach (the most common approach and is through an incision in the leg).
• The subclavian approach (through an incision near the shoulder).
• The transapical approach (through an incision in the chest between the ribs).
• The transaortic approach (through an incision in the upper chest).

Does my heart have to be stopped for TAVI?

No, unlike open heart surgery, TAVI does not require stopping the heart.

How could I benefit from a transcatheter valve replacement?

With the less invasive^7,8 TAVI procedure, people may return to daily activities sooner than with open heart surgery. People who undergo TAVI get back to life quicker^10-12 and report improved quality of life^13,14 following the procedure.

What is TAVR, and is it different from TAVI?

TAVR stands for transcatheter aortic valve replacement. The procedure and its approaches are the same as TAVI. Your doctor may use the terms interchangeably when discussing your treatment options.

How long have TAVI procedures been performed?

TAVI has been recognized as a treatment for aortic stenosis in Europe since 2007.

How many people have had the TAVI procedure?

More than 830,000 people worldwide have had a TAVI procedure.

Are there different types of transcatheter heart valves and can I ask for a specific valve?

Transcatheter heart valves are made by different manufacturers. You can check which valves are used and available at your hospital. Although you can ask for a specific valve, your doctor will recommend the best valve for you.

What are the potential risks or complications of TAVI?

The most serious risks of TAVI include death, stroke, serious damage to the arteries, or serious bleeding.

Is TAVI an option to treat patients who have bicuspid severe aortic stenosis?

Yes, TAVI may be an option for patients with a bicuspid aortic valve. Open heart surgery is not their only option (although it may be the best option for their unique situation). Only a Heart Team can determine which treatment option is best for the patient. Those with bicupsid severe aortic stenosis should seek an evalutation with a Heart Team to see all treatment options available for them.

How do I know if TAVI is right for me?

All severe aortic stenosis patients who are experiencing symptoms should be evaluated for all of their valve replacement options, including TAVI.¹⁵ The European Society of Cardiology has recently updated the guidelines for treatment of severe aortic stenosis. If you were told that TAVI was not an option for you in the past, you may be eligible now.

What tests will be done to determine if TAVI is right for me?

One or more of the following tests may be used to determine if TAVI is the best option for you.

• Chest X-ray: A type of imaging to view images of the organs and structures inside your chest. You will be placed between a metal plate and the X-ray machine. The X-ray technician will take several images of your chest in a variety of positions. This may take up to 30 minutes to perform.
• Transthoracic echocardiogram (TTE): This diagnostic test (also known as an echo) uses ultrasound to obtain 3D images of the heart. While you are lying on a table, a probe will be placed on your chest wall and will use sound waves to provide detailed pictures of your heart. This usually takes 30-60 minutes.
• Magnetic resonance imaging (MRI): A diagnostic test that uses magnetic and radio waves to take detailed pictures of your heart. You will be asked to lie down on a bed that moves into a large tube. You won’t feel anything but will hear a noise as the images are acquired. You will be asked to lie very still for duration of test. This usually takes 30-90 minutes.
• Pulmonary function test (PFT): A group of tests, using special breathing equipment, that will measure how well your lungs are moving oxygen to the blood. These can take 60-120 minutes.
• Computerized tomography (CT) scan: An imaging test that uses X-rays to obtain detailed pictures of your heart and blood vessels. You will be injected with contrast dye through an IV. You will be asked to lie down on a bed that passes through a donut-shaped X-ray scanner to take clear images of your heart. This takes up to 60 minutes.
• Angiogram (cardiac cath): An imaging test that uses X-ray and dye to see how blood flows through your arteries and veins. You will lie on your back on an X-ray table. A small incision will be made and a small tube, called a catheter, will be inserted either in your groin or near your elbow. Dye will be injected into the vessel to make the area show clearly on the X-ray pictures. This takes up to 60 minutes.
• Transesophageal echocardiogram: A test that obtains detailed pictures of your heart by inserting a probe down the esophagus (throat). While lying on a table, a technician will spray your throat with medicine to numb and suppress your gag reflex. A thin flexible tube will be guided down your throat. The probe will send and receive sound waves which will become pictures on a video screen. This may take up to 90 minutes.

Is TAVI only for people who are too sick or for whom surgery is too risky?¹⁵

More people are eligible for TAVI than ever before. TAVI may be an option for anyone with severe aortic stenosis who is experiencing symptoms. Only a specialized Heart Team can tell you if TAVI is right for you.

How can I get evaluated for TAVI?

To see if the TAVI procedure is right for you, you need to seek out expert care at a TAVI Hospital from a Heart Team that includes a specialized heart doctor called an interventional cardiologist. Only a Heart Team at a TAVI Hospital can evaluate you for both TAVI and open heart surgery to determine what the best treatment option is for you.

What is a Heart Team?

You may have heard the term Heart Team while researching your severe aortic stenosis treatment options. A Heart Team is a specialized care team that includes interventional cardiologists (TAVI Doctors), cardiothoracic surgeons, imaging specialists, anesthesiologists, cardiac cath lab staff, and a cardiologist. Together, the specialized Heart Team will conduct a comprehensive evaluation to determine whether the TAVI procedure is appropriate for you.

What if my doctor doesn’t know about TAVI or perform TAVI?

If your doctor doesn't perform TAVI, you can ask for a referral to a TAVI center. The doctors as TAVI centers are experts in valvular disease and valve replacement, and are able to determine the best treatment option for you.

What if my doctor does not think I am a good candidate for TAVI?

TAVI can be an option for more and more people with severe aortic stenosis.¹⁵ If your doctor does not think you are a good candidate for TAVI, you may still contact another doctor for a second opinion.

What should I expect directly after my TAVI procedure?

With the less invasive TAVI, comes less downtime. Typically following a TAVI procedure, you may be taken to the intensive care unit (ICU) for a little while or moved directly to a recovery room. Your doctor will update your caregiver or loved ones on how you are doing.

How long will I be in the hospital for my TAVI procedure?

With TAVI, many patients return home within a couple of days and have shorter recovery time, getting them to everyday activities.^10-12

What does life after TAVI look like?

Research has shown improved quality of life sooner with TAVI as well as improved health scores.^13,14

How long does a transcatheter heart valve last?

How long your tissue valve will last depends on many patient factors and medical conditions. Follow all care instructions to ensure the best possible results. Regular follow-ups will help your doctor know how your valve is working.

What happens if my transcatheter heart valve fails?

Every year after TAVI you should have a follow-up appointment with your cardiologist, who will be checking your heart. During these visits, your cardiologist will likely perform an echocardiogram and complete other tests to make sure your valve and heart are still working properly. If your cardiologist determines that your valve is no longer working the way it should, your doctor will determine next steps and decide if you need an evaluation for reintervention. If it is determined that another procedure is needed to fix your failing heart valve, and you have previously had a transcatheter heart valve to fix your severe aortic stenosis, you could be eligible to get another transcatheter heart valve placed into your failed artificial valve. This procedure is known as valve-in-valve and is currently approved for patients who are deemed high risk for open heart surgery.

What is open heart surgery?

Open heart surgery for aortic valve replacement is where the doctor will open your chest and will completely remove the damaged valve and replace it with an artificial valve. You will be connected to a heart-lung machine that does the work of your heart and keeps the blood flowing throughout your body. Patients usually need to stay in the hospital for a week or more, before beginning a long period of recovery.

How long does it take to recover from open heart surgery?

After open heart surgery, it can take the body a long time to recover. Your chest needs to be opened during the operation, and it can take several months to heal completely. Cardiac care rehabilitation is recommended.

What are the potential risks or complications of open heart surgery?

The most serious risks of open heart surgery include death, stroke, infection and bleeding.

What happens if my surgical heart valve fails?

During your routine checkups with your cardiologist, you will likely have an echocardiogram and complete other tests to make sure your valve and heart are still working properly. If your cardiologist determines that your valve is no longer working the way it should, your doctor will determine next steps and decide if you need an evaluation for reintervention. If it is determined that another procedure is needed to fix your failing surgical heart valve, you could be eligible to get a transcatheter heart valve placed into your failed surgical valve. This procedure is known as valve-in-valve and is currently approved for patients who are deemed high risk for another open heart surgery.

Are there resources available to better understand aortic stenosis and treatment options?

There are many free patient resources to help you manage your health and educate loved ones about aortic stenosis and treatment options, including patient stories, brochures and procedure videos. A personalized information kit is also available to help answer your questions on aortic stenosis and TAVI.