I had a lot of Rolling Stones fans ask me about the procedure Mick Jagger got for his heart earlier this month. While I don’t know him personally, I read on the news that he underwent a transcatheter aortic valve replacement/implantation – abbreviated as TAVR/TAVI. So before we go into too much detail – lets start with the basics.
What is aortic stenosis?
Your heart works hard every second of the day, pumping the necessary amount of blood throughout your body. It has four valves that play an important role in that process, one of which is called the aortic valve. The aortic valve has thin leaflets of tissue that open and close when the heart beats to regulate blood flow. Sometimes the leaflets of the aortic valve become stiff, which causes a narrowing of the aortic valve opening. This means the valve cannot fully open and close like it should. As the opening becomes smaller, it makes it harder for the heart to pump blood, which can cause problems like shortness of breath, dizziness and chest pain. This condition is called aortic stenosis.
Aortic stenosis affects more than 2.5 million people over the age of 75 in the United States and it’s expected to increase in prevalence as more people get older.
How is it treated?
Aortic stenosis is a progressive disease, which means it will get worse over time. Because of this, it is typically measured as mild, moderate, or severe aortic stenosis. The stage of aortic stenosis depends on how damaged the aortic valve is. When the aortic stenosis is mild or moderate, it may not interfere with the patient’s symptoms. As such, these patients need regular echocardiograms (ultrasound of the heart) every few years and should follow up with cardiologists regularly. However, severe aortic stenosis can progress rapidly into a life-threatening condition. Severe symptomatic aortic stenosis has typically been treated with open-heart surgery and replacement of the aortic valve – called surgical aortic valve replacement or SAVR. It was the gold standard of treatment until the last decade. However, given that these patients are usually old and have several comorbid conditions, they may not be string enough to make it through open-heart surgery and many patients would die without treatment.
Patients with severe aortic stenosis today, however, can expect much-improved quality of life and longevity than a decade ago, when the first patient was enrolled in the Placement of AoRTic TraNscathetER Valve (PARTNER) trials to investigate the efficacy of transcatheter aortic valve replacement (TAVR) among patients who were otherwise deemed inoperable. With TAVR, a replacement aortic valve can be inserted without open-heart surgery by puncturing a leg artery, inserting a new valve, threading it up to the heart and just popping it in place! It is a very short procedure – takes upto 2 hours. The patient is at the hospital for a few nights after which he/she can recover at home within 1-2 weeks. That compares with six weeks to three months of recovery for surgery.
Following approval in November 2011 by the U.S. Food and Drug Administration (FDA) of the initial transcatheter aortic valve prosthesis, more than 50,000 TAVR procedures were performed in the US across more than 250 centers through 2015. The FDA has expanded the indications for TAVR from prohibitive operative risk to high operative risk to finally intermediate operative risk in 2016, following results from several trials that proved TAVR to be superior or non-inferior to SAVR. In fact, the most recent results of the PARTNER -3 trial published just last month also prove TAVR to be superior to SAVR in low-risk patients. This is great news for hundreds of thousands of patients afflicted with this serious life-threatening disease who may not need to undergo open-heart surgery anymore.
If you have any questions about aortic stenosis, or TAVR, or anything about your heart, click here.