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Zachary Brewer, MD, a cardiac surgeon with Dignity Health Mercy Medical Group explains how to identify one of the most common and serious heart valve problems, aortic valve disease, or aortic stenosis. Aortic valve disease refers to severe narrowing or restriction of the aortic heart valve’s opening, reducing blood flow in the heart.

Some of the symptoms associated with a damaged aortic valve include:

• Breathlessness
• Chest pain or pressure
• Fainting
• Heart racing
• Leg swelling
• Fatigue

However, according to Dr. Brewer, aortic valve problems don’t always lead to noticeable symptoms. In fact, aortic stenosis might not have any symptoms at first, and when symptoms do develop, they are often mistaken for normal byproducts of getting older or being out of shape. 

Dr. Brewer explains, “When I carefully interview patients with an aortic valve condition, many times they tell me they cannot do things that were once possible, and that they have had to significantly alter their daily routines. These are more subtle symptoms of aortic valve disease.”

Aortic valve disease often isn’t apparent to those with the condition until the valve is very narrowed or is leaking excessively, at which point an aortic valve replacement (AVR) is usually necessary.

Dr. Brewer says open heart surgery has traditionally been the go-to intervention for AVR. During open heart surgery, an incision will be made near the breastbone to allow surgeons to access the heart directly. The heart will be temporarily stopped, and a heart-lung machine will support life functions while the valve is repaired.

While this approach has a longer recovery time than other AVR procedures, it is still considered the gold standard for AVR. It also allows the surgeon to address any other problems with the heart at the same time, including aorta enlargement or artery disease which might require replacements or bypass surgery.

AVR can also be completed using a “transcatheter aortic valve replacement” (TAVR) approach. With TAVR, a small tube is inserted through an artery in the groin with a collapsed valve loaded onto the end. Unlike open heart surgery, TAVR doesn’t require an incision in the chest, meaning that there is no need for a heart-lung machine. Once the tube, or catheter, reaches the valve, the new valve can be expanded, instantly pushing the old valve out of the way and the new valve takes over the job.

Dr. Brewer explains that “TAVR is an excellent option for people who may not be good candidates for surgery because of age or complicated medical issues.” TAVR also allows for a much faster recovery than traditional surgical methods. However, a disadvantage to TAVR is patients may still need to undergo additional procedures in the future if they have heart issues in addition to aortic valve stenosis, especially if they are younger.

Dr. Brewer does not necessarily recommend one AVR procedure over another. Instead, he takes a holistic look at each patient and tailors treatment specifically to the individual. Treatment depends on the anatomy and health status of the patient: a young adult in perfect health will likely be able to better withstand open heart surgery, whereas an elderly individual with limited mobility or additional medical issues might be a better candidate for TAVR.

Dr. Brewer says many patients fall somewhere in between those two extremes, and seeing a surgeon skilled in a range of AVR therapies is crucial to receiving the best and most appropriate treatment possible.

There are several types of replacement valves, including:

• Bioprosthetic surgical valves made from the sac lining the heart of a cow or a pig.
• Mechanical surgical valves made of carbon fibers. These valves are typically highly durable, but require the use of blood-thinners post-surgery.
• Self-expanding TAVR valves made from the lining of a pig’s heart.
• Balloon-expandable TAVR valves made from the lining of a cow’s heart.

Like the choice of AVR procedure, valve type selection can be tailored to each individual patient’s needs, according to Dr. Brewer. Age, health status, and lifestyle should all factor into the decision.

Dr. Brewer says, “It is important to visit a surgeon or clinician who offers all of the aforementioned types of procedures as well as valve-types so that the most educated and individualized decision can be made for treatment.”

Dr. Brewer says not to panic if you don’t notice immediate results following AVR: “Some people notice a difference immediately after their procedure, while others take longer to notice a change.” Prior to the procedure, the heart had to pump against a high amount of pressure in order to get the blood to flow through the damaged valve. Once that pressure is relieved, the heart remodels itself, or changes shape, and that can take time.

After any AVR procedure, patients can gradually return to their normal daily activities; the goal is to start walking as soon as the following day. TAVR patients often return to their previous routine within a few weeks after the procedure, says Dr. Brewer.

Recovery after open heart surgery requires more care and can take longer. Each patient is different, but the first month following surgery requires gradual, deliberate integration of previous activities. Patients are advised not to lift anything heavy and to avoid driving initially. After three months, patients can typically start to integrate more rigorous activities into their routine.