woman holding a heart

An Effective, Less Invasive Option for Heart Patients with Aortic Stenosis

Aortic stenosis is the most common form of valvular heart disease. Aortic stenosis is a progressive disease with increasing incidence with age, affecting up to 10 percent of the population by the eighth decade of life.

Patients develop symptoms due to left ventricular outflow obstruction resulting in decreased exercise capacity, angina, heart failure, syncope and death. Symptomatic aortic stenosis has mortality more than 50 percent at two years, unless treated promptly by aortic-valve replacement. The goals of intervention in aortic stenosis are to relieve symptoms, enhance exercise capacity and quality of life, and prolong life expectancy.

Symptoms onset is very important for deciding on the timing of valve replacement. Physicians need to be alert to the presence of a systolic murmur in older adults with exertional dyspnea, chest pain or dizziness. If the patient is asymptomatic but was found to have a severe aortic stenosis on an echo, detailed questions should be asked about levels of physical activity, and a possible treadmill stress test can be ordered to provoke symptoms and assess for functional capacity.

Diagnosis of aortic stenosis starts with physical examination suggesting systolic murmur and further confirmed by Transthoracic echocardiogram. In select patients, heart catheterization and invasive valve assessment is necessary to confirm severity of aortic stenosis. At times, exercise stress test (to elicit symptoms), transesophageal ECHO (for valve planimetry), CT aortic valve (to quantify valve calcification) and low dose dobutamine stress ECHO (to increase cardiac output and separate true from pseudo severe AS in pts with low LVEF) are needed to tease out the complex cases.

Pathogenesis aortic stenosis includes age-related degeneration of the tricuspid aortic valve due to lipid accumulation, inflammation and calcification leading to aortic stenosis presenting in the seventh or eighth decade of life. Although this degeneration process is accelerated in patients with congenital bicuspid aortic valve, therefore such patients present with aortic stenosis in the fifth or sixth decade of life.

There is no effective pharmacologic treatment for aortic stenosis. Surgical aortic valve replacement has been the only option in past, but many patients with aortic stenosis are not candidates for surgery or decline surgery for personal reasons. Over the last 10 years, Transcatheter Aortic Valve Replacement (TAVR) has emerged as an attractive, less invasive alternative to surgical AVR with equivalent or superior outcomes. With rapid advances in technology, operator experience, procedural refinement and supported by randomized controlled trials, TAVR use is rapidly increasing. TAVR is an established treatment for severe symptomatic aortic stenosis in appropriately selected patients of all risk categories.

At UTMB we have a successful and robust TAVR program in the setting of a multidisciplinary Valve Team. Our team has performed more than 130 TAVRs since 2017. Our team of interventional cardiologists and cardiac surgeons work side by side in evaluation and appropriate patient selection for surgical or transcatheter aortic valve replacement.

Our valve coordinator is Dawn Meyer, RN, (409) 772-0065. Please refer any aortic stenosis patient to our Valve Team via EPIC using “Valve Clinic Referral.”

Syed Gilani, MD, is Chief ad interim of the Division of Cardiology at UTMB Health, and a part of the TAVR team.

Cardiology Services