How is PCI different from bypass surgery?

Bypass surgery is open-heart surgery. PCI is a minimally invasive procedure that is done by an interventional cardiologist with the help of a catheter into your groin or arm

Why is my stent medicated?

In stents made up of only metal (Bare Metal stents), it was observed that the incidence of blood clot formation was higher. That is why a stent with a coating of the drug also called Drug-eluting stent or medicated stents are preferred. They release the drug at aslow rate to prevent blood clots from forming in a stent and thus prevent future blockage (restenosis) of the stent.

Choosing Health, Choosing Life: Treating Aortic Stenosis.

Understanding Aortic Stenosis and Its Treatment Options in India

22 December 2023

Aortic stenosis is a cardiac condition characterized by the narrowing of the aortic valve, which hinders the smooth flow of blood from the heart to the rest of the body. Traditionally, open-heart surgery has been the conventional approach for aortic valve replacement. Nevertheless, a novel procedure known as Transcatheter Aortic Valve Implantation (TAVI) has emerged as minimally invasive alternative. This blog aims to provide a complete grasp of aortic stenosis, delve into the advantages and considerations associated with TAVI, and shed light on this innovative treatment choice.

While medical treatments like diuretic therapy might temporarily alleviate symptoms of aortic stenosis, they are generally ineffective in the long term. In asymptomatic patients with aortic stenosis, the decision regarding valve replacement is less straightforward. Seeking advice from a cardiologist or cardiothoracic surgeon is advisable.

What Constitutes Severe Aortic Stenosis?

The aortic valve comprises three tissue flaps called leaflets. In a healthy condition, these valves open with each heartbeat, facilitating the forward flow of blood to the next chamber and then closing tightly to prevent any backflow. This unidirectional flow is crucial for a healthy heart.

Severe aortic stenosis occurs when the valve leaflets become rigid, diminishing their flexibility and ability to open and close adequately. It leads to a constriction (stenosis) of the valve opening. This constriction reduces blood flow, necessitating the heart to work harder. Consequently, oxygen-rich blood circulation from the lungs to the brain and the rest of the body is compromised.

Severe aortic stenosis is a progressive, age-related ailment. The primary cause is often the gradual accumulation of calcium (mineral deposits) on the aortic valve leaflets. In rarer instances, it could stem from a congenital heart defect, rheumatic fever, or radiation therapy.

Exploring Aortic Valve Stenosis Malfunction of the aortic valve with potentially life-threatening outcomes

The aortic valve governs the outlet of oxygenized blood from the left ventricle into the aorta. Aortic valve disease arises when the valve closing or opening is inadequate, leading to dysfunction. Aortic valve stenosis involves the thickening and stiffening of the valve, resulting in abnormal narrowing of the aortic valve opening and reduced blood flow. Consequently, the heart must exert more effort to propel adequate blood through the narrowed valve and throughout the body.

Symptoms and Diagnosis

Common symptoms linked to aortic stenosis encompass breathlessness during physical exertion (dyspnea), chest discomfort or tightness (angina), and episodes of dizziness or fainting (syncope).

If left untreated, severe aortic stenosis can eventually culminate in heart failure, severe infections, and sudden death. From the onset of aortic stenosis symptoms, the average survival rate is around 50% at 2 years and approximately 20% at 5 years.

Aortic stenosis is regarded as the most prevalent valvular anomaly. It can arise due to congenital abnormalities or infections such as rheumatic fever or endocarditis. However, the primary cause of aortic stenosis is calcific degenerative disease, where calcium accumulates on the valve cusps as age advances. Affecting roughly 7% of individuals over 65, aortic stenosis is the most prevalent valvular heart condition globally.

Treatment Options for Severe Aortic Stenosis

The treatment of severe aortic stenosis involves the replacement of the aortic valve. There are two primary options:

1. Surgical Aortic Valve Replacement (SAVR)
Surgical aortic valve replacement is performed through open-heart surgery. During this procedure:

The heart is halted, and a heart-lung machine circulates blood throughout the body.
A surgeon substitutes the diseased aortic valve with a prosthetic valve.
Recovery from open-heart surgery usually spans from weeks to months.

2. Transcatheter Aortic Valve Replacement (TAVR)
Transcatheter aortic valve replacement is a less-invasive approach that replaces the aortic valve without requiring a chest incision to access the heart. The procedure involves the following steps:

A small incision is made in an artery or blood vessel, most often in the groin, to access the heart.
An artificial valve is compressed onto a catheter, then threaded through a blood vessel to the heart, displacing the diseased valve components.
The replacement valve is expanded, pushing aside the diseased portion of the aortic valve. X-ray guidance aids in positioning and placing the new valve. Patients who undergo TAVR generally experience a smoother recovery process and reduced discomfort. The speed of recovery and return to daily activities depends on the individual’s overall health status.

3. Balloon Aortic Valvuloplasty
This procedure involves placing a balloon attached to a catheter within the aortic valve and inflating it to expand the calcified valve opening and enhance blood flow. While it may offer temporary relief, it might not be a viable long-term solution.

4. Medical Management
Medical management is an option for patients who are unsuitable for surgery or choose to avoid it. While it can provide temporary relief, it might not be a sustainable long-term solution.

References:

1. https://www.bostonscientific.com/en-IN/medical-specialties/structural-heart/sentinel-cerebral-protection-system/protected-tavrtrial.html
2. https://classic.clinicaltrials.gov/ct2/show/NCT04149535
3. https://pubmed.ncbi.nlm.nih.gov/36121045
4. https://consultqd.clevelandclinic.org/protected-tavr-finds-reduced-rate-of-disabling-stroke-with-cerebral-embolic-protection
5. https://my.clevelandclinic.org/health/diseases/23046-aortic-valve-stenosis

Disclaimer: The information presented by Boston Scientific India is for educational purposes only and does not recommend self-management of health issues. The information should not be treated as comprehensive and does not intend to provide diagnosis, treatment or any medical advice. Individual results may vary and hence, it is advisable to consult your doctor regarding any medical or health related diagnosis or treatment options.

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