New research suggests that people with failing heart valves would benefit from having their valves replaced sooner versus waiting. Traditionally, experts have often recommended that people with aortic stenosis take a wait-and-see approach to treating the condition.
The research, published in the New England Journal of Medicine, looked at people with asymptomatic severe aortic stenosis. It found that those who underwent a procedure called transcatheter aortic valve replacement (TAVR) saw more favorable outcomes than those who followed a conservative treatment approach.
“There’s still a lot to learn from the new research,” says Dr. Jagdeep Sabharwal, an Interventional Cardiologist with ThedaCare Cardiovascular Care. “However, it, shows promise in informing the recommendations we provide to patients with aortic stenosis.”
New Thinking
Many doctors have long recommended taking a conservative approach to treating aortic stenosis. If a patient didn’t have symptoms, they often were advised to undergo valve monitoring with imaging and periodic symptom checks.
Doctors frequently were reluctant to pursue surgery because it would require an open-heart procedure. Today, a less invasive surgery option is available. TAVR uses a catheter to implant a new valve within a person’s diseased aortic valve while their heart is still beating.
The recently released study examined the outcomes of TAVR versus a conservative treatment approach. It included 901 patients with asymptomatic severe aortic stenosis.
Patients were randomly assigned to groups, with 455 receiving a TAVR procedure and 446 undergoing clinical surveillance. Those who underwent a TAVR procedure saw a reduction in the incidence of death, stroke, or unplanned hospitalization for cardiovascular causes.
The study’s authors say more research is needed, but the results are promising.
Understanding Aortic Stenosis
Aortic stenosis is a narrowing of the aortic valve opening. It’s also sometimes referred to as a failing heart valve, according to the American Heart Association (AHA). The condition restricts the blood flow from the left ventricle to the aorta and also may affect the pressure in the left atrium.
The disease is most common in older adults. It affects more than 3% of adults 65 years of age or older, according to the New England Journal of Medicine study. Cases of aortic stenosis are expected to increase as people live longer lives.
Aortic stenosis typically results from scarring and calcium buildup in the heart’s valve cusp. The cusp is a flap of tissue on the heart’s valve that opens and closes with each heartbeat.
Young people also can develop aortic stenosis as a result of a birth defect. In this case, only two cusps grow instead of the normal three.
Other times, a valve opening might not grow along with the heart. This makes the heart work harder to pump blood to the restricted opening. Over the years, the defective valve often stiffens and narrows because of calcium buildup, according to the AHA.
Symptoms
Many people don’t experience symptoms of aortic stenosis until the amount of restricted blood flow becomes greatly reduced, according to the AHA.
Symptoms can include:
- Chest pain
- Rapid, fluttering heartbeat
- Trouble breathing or shortness of breath
- Feeling dizzy or light-headed, even fainting
- Difficulty walking short distances
- Decline in activity level or reduced ability to do normal activities
Risk Factors and Complications
Factors that increase risk for aortic stenosis include:
- Being assigned male at birth
- Being older than age 65
- Having high cholesterol
- Having high blood pressure
- Using tobacco products
When someone has aortic stenosis, it takes more effort to move blood through their aortic valve. The heart, in turn, works harder than it should to push the blood through. This can lead to a heart attack, heart failure, or sudden cardiac death.
Seeking Care
It’s important to stay on top of routine visits with your primary care provider. They can help you track and manage your heart health.
If you’ve been diagnosed with aortic stenosis or another heart condition, you’ll also likely see a cardiologist. They’ll monitor your condition, guide your treatment, and help you make positive lifestyle choices.
“It’s crucial to talk to your health care team about any heart symptoms you’re experiencing,” Dr. Sabharwal says. “Early intervention leads to better outcomes.”
