The diseased aortic valve: how it can be treated
As we age, our heart valves can begin to wear out, and heart valve disease is becoming more common. The most frequently treated condition is aortic valve stenosis, where the valve becomes narrowed. Treatment may involve open-heart surgery or a less invasive catheter-based procedure. The same options apply if the valve becomes leaky, known as aortic valve regurgitation.
Heart valve problems may be picked up during a routine check-up or when symptoms like tiredness, reduced stamina, or breathlessness appear. However, even severe valve disease can go unnoticed—especially if someone is less active and doesn’t feel symptoms during exertion.
Deciding when to treat a heart valve condition should be done by a specialist heart team. This team usually includes cardiologists, cardiac surgeons, anaesthetists, and GPs. For older patients, a geriatrician may also be involved. The goal is to carefully weigh the risks and benefits of treatment to ensure the best outcome for each individual.
Defective aortic valve, various treatment options
If the aortic valve is damaged due to narrowing (aortic stenosis) or leaking (aortic regurgitation), this is a mechanical issue that cannot be fixed with medication. However, medicines such as ACE inhibitors, angiotensin receptor blockers (ARBs), or digoxin may help relieve symptoms of heart failure. If you also have high cholesterol or arteriosclerosis (hardening of the arteries), these can often be managed with statins and a healthy lifestyle to help slow disease progression.
If the aortic valve becomes severely narrowed or symptoms begin to affect daily life, a valve replacement is usually recommended. Before surgery, your heart team will carry out tests to assess the severity and cause of the problem. One key test is an echocardiogram, which uses ultrasound to show how well your heart and valves are working.
Valve replacement without surgery?
The members of the heart team decide how an aortic valve is replaced and which material (biological heart valve or mechanical heart valve) is used. In addition to the patient's wishes, they also take into account criteria such as age and previous illnesses as well as the risks and possible treatment successes that can be expected with a minimally invasive procedure such as transcatheter aortic valve implantation (TAVI) compared to surgery.
If the decision is made in favour of TAVI for severe aortic valve stenosis or a leaking aortic valve, the new biological aortic valve, which is folded into a fine tubular metal mesh and made of animal tissue, is usually delivered into the heart via the inguinal artery to the defective aortic valve using a catheter. It is not removed, but pushed aside by the metal mesh. Once the new aortic valve has been placed in the correct position, the doctor implant the new aortic valve, which immediately takes over the function of the old one. Soon after the procedure, the stressful symptoms may subside.
The best method ...
.... varies from person to person. The TAVI method is generally less stressful than a surgical procedure. This is because the small incision in the groin and the light anesthesia or local anesthesia of the catheter-based method shortens the hospital stay - in addition, the chest does not have to be opened during TAVI and the patient is spared the use of a heart-lung machine. This is a particular advantage for those who are frail or of advanced age or suffer from other illnesses and for whom a conventional operation would therefore be too dangerous. Nevertheless, TAVI can also be performed under general anesthesia if the heart team deems this to be the more sensible procedure for the patient.
However, the TAVI method only allows the use of biological aortic valves, as these can be folded up in contrast to a mechanical heart valve. This allows them to fit through the blood vessels that lead to the heart.
However, animal tissue wears out over time and must then be replaced, just like the original aortic valve. For younger people, this may mean that they have to undergo this procedure a second time at an advanced age. It is also important that the biological aortic valve enables any necessary cardiac catheterization without any problems, so that younger patients in particular, who may later develop coronary heart disease, still have all diagnostic and therapeutic options open to them.
The operation does not limit the choice between a mechanical heart valve made of metal, plastic or a biological heart valve. If the decision is made in favor of a mechanical heart valve, it will last a lifetime, but requires treatment with anticoagulants for just as long.
It is therefore not an easy decision to make, as many different factors play a role. But don't worry: your treatment team will consider all the advantages and disadvantages of the various treatment options and then suggest the best alternative for you.