If it is decided that your heart valve disease requires treatment, our clinical team will review treatment options with you. At this time, drug therapy does not exist to treat aortic valve disease. There are some medicines that can improve how you feel, however only in the short-term.
The gold standard for treating significant aortic valve disease is open-heart surgery, a safe and highly effective treatment for most patients. The aortic valve is repaired or replaced with a bioprosthetic (tissue) or mechanical valve. The surgeon makes an incision down the center of the sternum (breastbone) to access the heart. The procedure may require a sternotomy (opening of the chest bone) or may be performed through a lesser invasive approach using a small incision to access the aortic valve. Patients are placed on a heart-lung bypass machine which temporarily takes over the function of the heart and lungs, maintaining blood circulation during portions of the procedure. Mortality for open-heart surgery at our institution is consistently well below the national average for academic medical centers, and the rate of all major complications is under two percent.
Learn more about aortic valve surgery by following the link: http://dev.columbiasurgery.org/aortic
Approximately 300,000 people in the United States have aortic stenosis, and about one third of these patients are too sick or too old to undergo surgical replacement. A minimally invasive technique, called Transcatheter Aortic Valve Replacement (TAVR), is available for these patients. A prosthetic valve is delivered to the heart with a catheter guided by a special type of x-ray. The prosthetic valve is carefully positioned inside the patient's own valve and expanded. The diseased leaflets are pushed aside and replaced with the new valve which will immediately begin to function.
The replacement valve may be advanced to the heart through either the femoral artery or transapically, a minimally invasive technique where a small incision is made under the left chest and the valve is advanced from just below the heart, designed for people whose femoral vessels are not appropriate for transfemoral access. The Transaortic Approach involves direct access to the aorta via a mini-sternotomy directly above the breast bone. This approach is appropriate for patients who have inaccessible femoral arteries and are unsuitable for the transapical approach, often because of poor respiratory function. Our team of physicians will evaluate your medical records and images to determine the best approach for you.
There are risks associated with both TAVR and surgery. Our physicians will outline the risks during your evaluation appointment.
Click here to view an animation of the transfemoral approach to TAVR
Click here to view an animation of the transapical approach to TAVR
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