Aortic Stenosis

Saint Luke’s Valve Center is dedicated to the use of new transcatheter valve replacement therapies for patients with complex valve disease. We were one of the first hospitals in the country—and the first in Kansas City—to offer transcatheter aortic valve replacement, a key option for patients who may be too high risk for traditional valve replacement.

The Valve Center unites a highly-skilled team of cardiologists and cardiovascular surgeons who offers diagnosis, evaluation, and treatment in one convenient location. By having all our specialists together, you won’t experience the extra stress of rushing from building to building for appointments. And you’ll have access to the latest therapies and clinical trials.

Patients who are deemed inoperable or too high risk for traditional open heart surgery may undergo a new procedure called transcatheter aortic valve replacement (TAVR). This new procedure allows the diseased native heart valve to be replaced without open heart surgery. In addition to treating patients too high risk for standard surgery, ongoing research studies only available at Saint Luke’s have allowed us to consider patients who are lower risk for this novel procedure. Potential advantages of transcatheter aortic valve replacement (TAVR) for such patients may include fewer complications and a more rapid and less painful recovery period.

The TAVR procedure was first performed in France in 2002. More than 20,000 patients worldwide have received this heart valve. Saint Luke’s Mid America Heart Institute was one of the first U.S. hospitals to implant this valve.

Aortic Stenosis

Heart Valve Problems: Aortic Stenosis

Aortic stenosis means your aortic valve has a problem opening. The left ventricle has to work harder to push the blood through the valve. In some cases, this extra work will make the muscle of the ventricle thicken. In time, the extra work can tire the heart and cause the heart muscle to weaken. Stenosis usually get worse slowly, over many years. But sometimes it can quickly get worse.

Cross section of heart showing aortic valve with stenosis.

Cross section of heart showing aortic valve with stenosis.

Open aortic valve with stenosis (viewed from above).

Cross section of heart showing aortic valve with stenosis.

Possible causes

Calcium deposits can form on the aortic valve as you get older. These deposits make the valve stiff and hard to open. In some cases, you may have been born with an abnormal aortic valve. Or your aortic valve may have been damaged by rheumatic fever or a heart infection.

 

Treating aortic stenosis

In many cases, treatment won’t be needed unless you have symptoms. If you do have symptoms, medicines may help relieve them. If the stenosis is severe, your doctor may recommend surgery to replace the valve, even if you don’t have symptoms.

Understanding TAVR

Understanding Transcatheter Aortic Valve Replacement (TAVR)

Front view of male figure showing cardiovascular system with catheter inserted in femoral artery to carotid artery. Other possible catheter insertion sites shown.Transcatheter aortic valve replacement (TAVR) is a procedure to replace a diseased aortic valve with a new tissue or biologic valve. The old heart valve is not removed but acts like an anchor for the new heart valve. This procedure is done through small incisions using a long thin tube (catheter), X-rays, and ultrasound.

The aortic valve controls blood flow from the heart to the body. In some people, the valve becomes scarred and stiff and has trouble opening. This is a condition called aortic stenosis. The heart then has to work harder to push blood through the narrowed heart valve to the rest of the body. Over time, the extra work can cause the heart muscle to weaken. This may lead to symptoms such as tiredness, shortness of breath, chest pain, and fainting. It can lead to heart failure.

In TAVR, the catheter is usually placed in the femoral artery in your groin. Sometimes, the catheter is placed through a small incision in your chest underneath the collarbone or an incision between the ribs. The doctor uses the catheter to bring the new valve to your heart. The new valve is made of cow or pig heart tissue and is mounted on a metal frame. The new valve helps improve blood flow from the heart to the rest of the body.

Reasons for TAVR

TAVR is an option if you are at higher risk traditional open-heart surgery to replace a valve. TAVR may be an option if you have:

  • Advanced age

  • A weaker heart

  • Previous heart surgery

  • A history of stroke

  • Chronic obstructive lung disease

  • Coronary artery disease

  • Kidney disease

  • Diabetes

  • Previous radiation treatment to the chest

  • Porcelain aorta, extensive calcium around the aorta that would make open heart surgery impossible or difficult

  • Frailty or physical disability that would make recovery from an open heart surgery challenging

TAVR may also be a choice for you for other reasons. A team of doctors makes the decision to do this surgery on a case-by-case basis.

Risks and possible complications

TAVR is very effective in most people. However, all medical procedures carry some risks and possible complications. Some common risks of TAVR include:

  • Bleeding or the need for a transfusion

  • Anemia (not enough red blood cells in the blood)

  • Blood clots

  • Infection

  • Collection of fluid around your heart

  • Confusion or memory problems

  • Damage to the heart

  • Damage to your blood vessels

  • Failure of the new valve

  • Heart attack

  • Heart rhythm problems that may require a pacemaker

  • Kidney damage or failure

  • Lung puncture

  • Stroke

  • Risks of anesthesia (including death)

  • Rarely, the new heart valve can move out of position after it has been implanted

  • Leaking of blood in or around the new heart valve

You may have other risks, depending on your medical condition. Be sure to talk with your doctor if you have any concerns before the procedure.

Life after a heart valve replacement

  • A new heart valve can help ease symptoms you may have had. These include pain or pressure in your chest, shortness of breath, and tiredness.

  • After the surgery, you will need to take aspirin or other blood-thinning medicine every day. You will likely also need to take an anti-platelet medication such as clopidogrel  for a certain period of time. These medicines help prevent blood clots in your new valve.

  • You will need to take antibiotics before you have dental work, as prescribed by your healthcare provider. This is to help prevent bacteria from harming your new heart valve.

  • Your healthcare provider may tell you to make some lifestyle changes to protect your heart and make it stronger. These include exercise, quitting smoking, and keeping a healthy weight.

  • After your recovery from TAVR, you may be able to return to regular activities with a noticeable improvement in the symptoms from your heart valve disease. Be sure to talk to your doctor before starting any exercise program.

Valve replacement: Two Sisters, Two TAVRs, Two Weeks
Sisters outlived their heart valves and had TAVRs two weeks apart. Read how this simple procedure helped them get back to life.
Study shows promising results for minimally invasive heart valve replacement option

Patients who are considered non-operable for conventional open heart valve surgery may have promising options using a new treatment available in the region only through Saint Luke's Mid America Heart Institute.

Valve Center at Saint Luke’s streamlines diagnosis and treatment

Building on a tradition of excellence in the treatment of heart valve disease, Saint Luke’s Mid America Heart Institute has established a comprehensive multidisciplinary Valve Center dedicated to the use of new transcatheter valve replacement therapies for patients with complex valvular disease. The center unites a highly skilled team of cardiologists and cardiovascular surgeons offering diagnosis, evaluation, and treatment in one convenient location.

Heart Valve Replacement without Invasive Surgery

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Saint Luke's Cardiovascular Consultants

A leader in cardiac care, Saint Luke’s Cardiovascular Consultants treats patients throughout the Kansas City area and surrounding communities. Our medical team consists of both board-certified clinical cardiologists as well as physicians certified in specialty areas of cardiology including interventional cardiology, echocardiography, nuclear cardiology, preventive cardiology, and electrophysiology.