In most cases, the anesthesiologist uses twilight anesthesia (conscious sedation, which is a combination of a sedative to help you relax and an anesthetic to control pain). This avoids the need for a breathing tube and makes it possible for you to move around sooner after the procedure.
In inset, see angiography of patient with aortic stenosis, showing minimal leaflet opening. In main picture, see angiography after TAVR valve placement.
The U.S. Food and Drug Administration (FDA) only approved TAVR therapy for patients who are intermediate-, high- or extreme-risk for open-heart surgery. However, Swedish is participating in an important research study that will offer low-risk patients either open-heart surgery or TAVR to replace their damaged aortic valves. Results of the study will help inform the FDA as they determine whether to approve TAVR therapy for all patients with aortic valve disease.
Swedish is also participating in clinical trials with next-generation TAVR valves and trials that make TAVR even safer. For more information about TAVR research, visit Structural Heart and Valve Disease Research ›
Transcatheter Aortic Valve-in-Valve Replacement
Bioprosthetic valves are made from animal valves or tissue, and usually last 10-20 years. That is why younger patients who have had a valve replacement using a bioprosthetic valve may need to have it replaced at some point.
Swedish offers the option to replace a surgical bioprosthetic aortic valve using open-heart surgery, or replacing the surgical bioprosthetic valve with a transcatheter aortic valve. Advantages of the latter option include a shorter hospital stay, use of conscious sedation and a quicker recovery time.
Transcatheter Balloon Aortic Valvuloplasty
Balloon aortic valvuloplasty is a procedure to widen the opening in an aortic valve that has narrowed due to stenosis. Balloon valvuloplasty is a procedure that is used in place of valve replacement in children, teens and young adults who have congenital stenosis. It may also be used as a “bridge” for older adults who are too sick to have a valve replacement procedure right away. In older adults who have had balloon valvuloplasty the stenosis may return in six to 12 months, which would then require a valve replacement procedure.
You will be awake during the procedure, but your anesthesiologist will administer local anesthesia and other pain medicine to minimize pain and ensure you are relaxed. Your cardiologist will insert a catheter through a very small incision in your groin, and will then thread it through an artery into your heart and valve. After ensuring proper placement, your cardiologist inflates the balloon at the end of the catheter. This therapy can offer a short-term solution to individuals with severe aortic valve stenosis.
Open Repair or Replacement Surgery
Open-heart surgery is the most common treatment to repair or replace a damaged aortic valve in young and healthy adults. You will be under general anesthesia. Your heart surgeon will make a long incision in your chest and through your breast bone to allow access to the heart and aortic valve. Throughout the entire procedure your blood will circulate through a cardiopulmonary bypass (heart-lung) machine (keeps blood circulating through your body, but diverts it around the valve that is being replaced. The pump is often called a heart-lung machine.) If your valve is very damaged, your surgeon will replace it with a mechanical valve (an artificial valve used to replace a damaged heart valve, usually made out of titanium or carbon) or a bioprosthetic valve (an artificial heart valve made out of animal tissue, usually from a pig), rather than trying to repair it.
After surgery, you will recover in the hospital for a few days and then at home for several weeks or possibly a couple of months.
Elderly individuals and those who are very frail or have multiple medical conditions may not be eligible for open-heart surgery.
For more information about open-heart aortic valve surgery, visit Swedish Cardiac Surgery ›
Minimally Invasive Aortic Valve Replacement
Heart surgeons at Swedish are able to repair or replace mitral valves using a minimally invasive approach, performed through very small incisions to reduce the trauma to the body. Your surgeon may choose to repair or replace your aortic valve using a procedure called a mini-sternotomy. It is similar to open-heart surgery, except the surgeon makes only a four- or five-inch incision in the upper part of your chest and only spreads the upper portion of your breast bone. In some cases, the incision can be even smaller, resulting in a quicker recovery.
For more information about minimally invasive surgery for aortic valve replacement, visit Swedish Cardiac Surgery ›
Surveillance and Medical Management
Aortic valve stenosis and aortic valve regurgitation can develop over time. Therefore, you may have mild or no symptoms at first. At first, your doctor may want to monitor your condition during regular visits and may prescribe medicine to help control your symptoms. For example, you may take medicine to reduce fluid build-up, lower your blood pressure, slow your heart rate or control your heart’s rhythm. Your doctor may order repeat echocardiograms to evaluate the progress of your aortic valve disease. Eventually, as your symptoms worsen and they begin to affect your quality of life, your doctor may recommend a procedure or surgery to repair or replace the damaged valve.