Aortic Valve Treatments

Reviewed by Columbia Structural Heart and Valve Center Faculty, July 2024

At a Glance

  • Aortic valve disease can lead to serious complications like stroke, heart failure, and death.
  • Transcatheter Aortic Valve Replacement (TAVR) is a minimally invasive treatment that implants a device to take over for the diseased aortic valve without open surgery.
  • Both TAVR and Surgical Aortic Valve Replacement (SAVR) are effective treatments for aortic stenosis, but which treatment is appropriate will depend on a number of factors. 

What is the Aortic Valve?

The aortic valve controls blood flow from the left ventricle into the aorta, the largest blood vessel in the body. It has three leaflets (flaps, or cusps) that open and close.

What is Aortic Valve Disease?

Aortic valve disease keeps the valve from properly managing blood flow. This causes the heart to work harder, and over time, this causes damage to the heart. Different types of aortic valve disease include:

  • Aortic regurgitation (AR) or Aortic Insufficiency: The aortic valve cannot fully close, causing blood to flow backward into the heart. This reversed flow creates pressure that can cause structural damage to the heart.
  • Aortic Stenosis (AS): The aortic valve stiffens and narrows. The heart is forced to work harder, which can lead to long-term damage (heart failure).
  • Congenital Aortic Valve Defects: Some people are born with an aortic valve that only has two cusps (bicuspid aortic valve) or otherwise does not function correctly.

If left untreated, aortic valve disease can significantly impact quality of life, and can lead to complications like stroke, heart failure, and death. 

How is Aortic Valve Disease Treated?

Medications

Medications are not an effective long-term treatment option for aortic valve disease and are limited to addressing symptoms and avoiding complications like stroke. These include: 

  • Antiarrhythmics
  • Beta blockers
  • Blood thinners
  • Diuretics

Transcatheter Aortic Valve Replacement (TAVR)

TAVR is a minimally invasive procedure that accesses the heart without open surgery. 

  • Advanced cardiac imaging technology is used to guide the procedure, allowing the team to “see” the structures of the heart and circulatory system.
  • A sheath and guidewire are inserted into a blood vessel in the leg or neck and then guided up to the heart.
  • The TAVR device is passed along the guidewire using a catheter up to the diseased aortic valve.
  • Once in place, the TAVR device is deployed, expanded, and implanted into the existing diseased valve or failed surgically implanted bioprosthetic (tissue) heart valve (Valve-in-Valve procedure).
  • Once completed, the wire and catheter are withdrawn. 

Most of these procedures are performed without general anesthesia, with patients awake. Patients can usually go home the next day. 

This life-saving device originally provided a treatment option for patients who were too sick or too old to undergo a surgical replacement. It is now FDA approved for all patients independent of surgical risk. 

TAVR is now an option for the majority of patients with aortic stenosis, offering a much shorter recovery time and lower procedural risk than open heart surgery.

Surgical Aortic Valve Replacement (SAVR)

During open heart surgery using general anesthesia, a mechanical or biological tissue valve is implanted to replace the damaged aortic valve. This type of treatment is highly effective, but is associated with a longer recovery time. This approach is most appropriate for younger, healthier patients with a longer life expectancy.

TAVR vs SAVR: Which Treatment is Right for Me?

Which treatment is appropriate will depend on multiple factors, including:

  • Age and life expectancy
  • Anatomy (size of blood vessels, number of valve flaps, degree of aortic valve calcification, etc.)
  • Surgical risk
  • Overall health
  • Other health concerns (comorbidities)
  • Medication requirements
  • Personal preferences 

Aortic Valve Repair

Some aortic valve conditions can be repaired as an alternative to replacement or as a bridge to replacement. These include:

  • Transcatheter balloon valvuloplasty: a minimally invasive transcatheter procedure that can provide short-term relief for symptoms prior to valve replacement. A balloon catheter is inserted into the aortic valve and inflated. This opens the valve and increases blood flow into the aorta.

What is Recovery for Aortic Valve Treatment Like?

Recovery from aortic valve treatment will vary based on several factors, including:

  • The type of treatment 
  • The severity of disease
  • Additional heart conditions 
  • Previous surgeries
  • Age
  • Overall health

In general, transcatheter procedures require less recovery time than surgical treatments. The majority of patients go home the next day after the procedure in good health, with no restrictions after one week.

Patients may also take medications after treatment to control blood pressure or reduce the risk of blood clots. 

Next Steps

Aortic Valve Disease can have a significant impact on your overall health and quality of life, and getting treated is just part of the plan. Because valve disease can lead to serious health problems like heart failure, it’s essential to work with your cardiologist and valve care team to monitor and manage your long-term heart health.

Columbia is a world-leader for heart valve care, with the expertise and experience to support your needs for years to come. To learn more about partnering with the Columbia Structural Heart and Valve Center for your care, call us at (212) 342-0444 or complete our online application form. 

We accept most major insurance plans and can verify your plan when you call to make your appointment.