Aortic valve disease is a life-limiting condition that can affect both young and old alike. One of the four main valves in our heart, aortic valve is essential for blood to flow from your heart properly into other parts of the body. If this valve does not work properly, patients face deadly consequences. Surgical intervention is considered a gold standard for many. However, not all patients are eligible for open-heart surgery given reasons like age, comorbidities or frail. In this paper, we provide an overview of inoperable aortic valve disease and alternatives for TAVI (TAVR) treatment.
What is Aortic Valve Disease?
Aortic valve disease refers to a complex of diseases, wherein the proper functioning of the aortic valve is impaired. Most common flavors of business are:
- Aortic Stenosis: When the aortic valve is narrowed it does not open fully and decreases blood flow from the heart into then onto the body. The heart eventually has to pump harder into the narrowed valve which can cause it to become a stiff muscle, leading to congestive heart failure.
- Aortic Regurgitation: This is a condition in which the aortic valve does not close tightly, allowing blood to flow backward into the heart. This can make the heart work harder and increase your risk for issues like a larger, fatigued heart or even result in you having congestive cardiac failure.
- Bicuspid Aortic Valve Disease: Some people are born with a bicuspid valve, which is made up of two cusps (or flaps) instead of three. In the long term this can result in stenosis or regurgitation (back flow).
Severe aortic valve disease is common and has devastating consequences to the patients with it.
Open-heart surgery to repair or replace the aortic valve is typically recommended in many patients. However, some patients are considered inoperable for one or more reasons:
- Infection especially in advanced age: Older patients run a greater risk of surgery complications which may include infection, longer recovery times and increased mortality.
- Multiple Comorbidities: Patients with other significant health issues like chronic kidney disease, lung or diabetes might not be able to withstand the strain of major surgery.
Frailty is prevalent in older surgical patients and places these individuals at greater risk for adverse postoperative events with longer recovery periods.
Traditional open-heart surgery is far too dangerous for these patients. Some recent leaps in medical engineering have brought new treatment options that may turn out to be a life-saving choice for victims of severe or high-risk surgical-type aortic valve problems.
TAVR (Transcatheter Aortic Valve Replacement): A Very Good Alternative
Transcatheter Aortic Valve Implantation (TAVI), also referred as Trans Catheter Aorta valve Replacement ) TAVR is one of the major breakthroughs in treating non-operable and high risk aoritic valvular disea ses. TAVI is a less invasive procedure than open-heart surgery that allows doctors to replace a narrowed or blocked aortic valve.
The TAVI Procedure
The TAVI procedure involves placing a new valve into the heart via catheter (thin tube), often in the groin and entering through your femoral artery. The new valve sits inside the existing aortic valve and starts to work right away by opening up more fully helps increase blood flow, relieving symptoms.
- Less Invasiveness: TAVI is less invasive when compared to an open heart surgery, which makes it a better option for patients where traditional surgical treatment would present a higher risk.
- Faster Recovery: Often, patients who undergo TAVI have a faster recovery time than those opting for open heart surgery. Elderly, Frail Patients May Benefit Most
- Symptom Relief: TAVI helps alleviate the symptoms such as shortness of breath, chest pain and fatigue in patients with aortic stenosis thereby improving quality life.
Patient Selection for TAVI
Patients who fulfil the definition of severe aortic valve disease should be considered for TAVI. It is primarily indicated in high risk or non-operative candidates for open heart surgery. Candidates require a comprehensive review by an interdisciplinary heart team consisting of cardiologists, cardiac surgeon and other experts. Factors considered include:
- Severity of Aortic Valve Disease: TAVI is generally indicated in patients with severe aortic stenosis who are symptomatic.
- General Health: Patients must be assessed for comorbidities that could undermine procedural success.
- Aortic Valve Anatomy: This includes the morphology, and size of your aortic valve as well as ancillary vasculature through which TAVI can be delivered.
Treatment for Inoperable Patients
TAVI is the more routinized alternative for AS patients who are considered inoperable, but other treatments might be suitable if you or your healthcare provider does not feel TAVI would work best.
Balloon Aortic Valvuloplasty (BAV) -- stands for Balloon aortic valolveplasty and refers to treating the stenosis of the aortic valve with balloon catheter.
Balloon Aortic Valvuloplasty (BAV), in this procedure a balloon-carrying catheter is placed and inflated at the narrowed valve. This enlarges the valve opening, in turn increasing blood flow. Nevertheless, BAV is almost always considered as a temporary measure and more of a bridge to definitive therapy such as TAVI.
Medical Management
Medical management may be the only reasonable option for some patients, particularly those with limited life expectancy or an exceptionally high surgical risk. The current approach is to treat the symptoms of disease after they have arisen and improve a patient's quality of life through empirically tested drugs that reduce inflammation. Common medications include:
Diuretics — reduce fluid retention and relieve heart failure symptoms
Beta-blockers: These also help to lessen the load on broken heart chambers by slowing the center rate and reducing blood pressure, thereby making it easier for everyday living pumping.
ACE Inhibitors –These drugs relax blood vessels and the lower workload on your heart.
Medical management, while not a cure for aortic valve disease, is valuable in controlling symptoms as well as can improve the quality of life of patients who are unsuitable for surgical or catheter-based procedure.
Early Detection and Monitoring are Critical
Detection and monitoring for patients with aortic valve disease Cardiologist visits on a regular basis can help measure the advancement of the sickness and decide what sort of remedy is necessary. Even when surgery is not possible, earlier intervention may improve outcomes and quality of life.
Diagnostic Tools
- Diagnosis and Follow-Up: Aortic Valve Disease can be graded in Severity using Several Diagnostic Tools which are as follows:-
- Echocardiogram: Provides pictures of the aortic valve and identifies any blood flow problems through this area
- Cardiac MRI: Creates detailed images of the structure and function of your heart so that provides insight into how much valve disease there is.
- Cardiac Catheterization: During this procedure, a catheter is inserted into the heart to evaluate pressure measurements and determine how narrowed or leaking your valves are.
Quality of Life Impact
One of the most common cardiac conditions in patients with AS are related or non-related to aortic valve diseases is helping manage symptoms and quality-of-life issues, especially for those who have been diagnosed (or misdiagnosed) secondary ASA. Patients frequently have debilitating symptoms, such as shortness of breath, fatigue and chest pain that impair their daily function due to the advanced stage of these diseases.
Symptom Management
Symptom management has the ability to enhance his/her quality of life. Esto puede incluir la administración de medicamentos, cambios en el estilo de vida y procedimientos como TAVI o BAV cuando sea conveniente. Patients are encouraged to:
Participants should: exercise on a regular basis (exercise appropriate to one's condition); returning again, light-to-moderate exertion can enhance cardiorespiratory wellness and psychological well-being.
Diet for a Healthy Heart If you have heart failure, your diet will need careful management from the start of diagnosis to help control symptoms and complications
Cut Out Smoking and Drinking: It has been shown that smoking can have an adverse effect on the health of heart, as well further increasing these risks.
Palliative Care
In some cases, primarily those with impaired life expectancy or very advanced disease, palliative care might be the most suitable treatment. The primary goal of palliative care is to help people live as well as they can with a serious illness by providing relief from symptoms, pain and stress.
The Role of Caregivers
For patients with inoperable aortic valve disease, the caregivers are critical. They offer emotional support, assist with daily living and manage medical care. Caregivers should be provided with details of the patient's condition, treatment options and opportunities to discuss these matters with the healthcare team.
Supporting Caregivers
Caregiving can be an incredibly demanding, both physically and emotionally. Caregiver resources and supports (such as support groups, counseling, or respite care) can be beneficial to balance a caregivers life responsibilities with their need for self-care.
PREDICTION: What's on the horizon in treatment?
The management of severe aortic valve disease inoperable patients has evolved. Improved techniques of TAVI and development of new technique, carried away by the research work in technological advancements The use of TAVI is currently being tested in clinical trials for broader patient populations — including those who are younger, have more mild disease or a different type of valve disease.
Personalized Medicine
Personalized medicine has been an evolving strategy as our knowledge of aortic valve disease improves, making treatment specific for each unique patient scenario. This may require genetic testing, advanced imaging techniques and other methods to tailor the treatment.
Conclusion
Patients with inoperable aortic valve disease pose unique challenges, but new medical technology offers hope for those who are ineligible to have traditional open-heart surgery. Less invasive procedures, such as TAVI, provide a safe and effective option for patients. Early detection, ongoing awareness and a methodologic approach to addressing symptoms may be useful in improving quality of life these patient populations. Moving forward, new treatments that can provide hope and improve the quality of life for patients who suffer from this chronic malady are on the horizon as research is continuing to evolve.
