Ask a Texas Heart Institute Doctor
Informed patients make better patients.
Question:
Do I need to have AVR soon, and if so, can I have a TAVR?
In September of 2008 I was referred by my primary physician to the
Piedmont Heart Institute for an abnormality detected during an
electrocardiogram during a routine physical. They performed an
echocardiogram and a stress test and diagnosed me with aortic stenosis.
At that time, and until this day, I have no physical symptoms commonly
experienced with this condition such as chest pains, shortness of
breath, light headedness or weakness. They suggested at that time that
somewhere along the way I was probably going to need to have my aortic
valve replaced. They said my two choices were a pig valve or a
mechanical valve. I did a little research and learned about the TAVR. I
brought this up with them on one of my visits and they said it was still
experimental and I was not a candidate for that procedure, but I may be
down the road. They suggested as long as I felt well I could come in
for a checkup every 3 months and to call them immediately if I
experienced any problems. Last month I made my 27th visit to PHI. In
that time frame I have had 6 echocardiograms, 3 stress tests, 1 heart
cath, and a CT scan, lost 35 pounds and gone from 69 years old to 76
years old. During my last visit they told me that a TAVR for me was
still about 2 years away.
I have two concerns:
- Feeling as well as I do, does anything need to be done at this point other than closely monitoring the situation?
- If I do need to have it replaced, why not TAVR?
From what I read TAVR is really not an experimental procedure anymore. I
would very much appreciate your opinion on what you think I should do
moving forward. I am still very active. I am in my own business, go to
work every day and pretty much do everything I have for the past twenty
years just maybe a bit slower. I would it to like to continue that way.
submitted by Conrad from Georgia on 03/06/2015
Answer:
by Texas Heart Institute cardiovascular surgeon, James J. Livesay, MD
Symptoms of aortic stenosis usually progress as the severity of the obstruction gets worse, but not always. Because heart attacks, heart failure, loss of consciousness and sudden death can occur without warning, surgery is recommended when the degree of obstruction becomes severe. This can be determined by an echocardiogram. Surgical aortic valve replacement is recommended in most patients with severe aortic stenosis and can usually be accomplished with a low risk (less than 2% risk of death or stroke). TAVR is approved for patients at high risk for surgery because of advanced age and concomitant disease in other organs or extreme frailty with an estimated surgical risk of 8% or more. From what you have written, I suspect the degree of stenosis is not severe, but you should discuss this with your cardiologist. Some valve companies are beginning clinical trials (experimental) on intermediate risk patients with predicted risk 4-8%, but these are not for patients with severe aortic stenosis.
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Updated March 2015
