The Aortic Valve and Related Conditions
What is the Aortic Valve?
The aortic valve sits in between the aorta (the main blood vessels in the body) and the left ventricle (the main pumping chamber of the heart). It is designed to ensure that oxygen rich blood moves forward from the heart to the rest of your body.
The aortic valve sits between the aorta and the left ventricle
What is Aortic Stenosis?
Aortic valve stenosis (AS) is a disease of the aortic valve in which the opening of the valve is narrowed (stenotic). The normal size of the aortic valve is the size of a half dollar; a severely stenotic valve may be the size of a dime or smaller.
Aortic stenosis is narrowing of the aortic valve.
What are the symptoms of aortic stenosis?
Narrowing of the aortic valve increases the effort required by the heart to adequately pump blood to the body. Over time heart function will deteriorate, and the patient will develop symptoms. Symptoms include:
- shortness of breath,
- chest pain, and
- loss of consciounsess (syncope).
If untreated, 50% of patients with severe aortic stenosis die 2 years after symptoms are detected.
Aortic regurgitation is leaking of the aortic valve.
What is the treatment for aortic valve disease?
Treatments for aortic valve disease include:
- conventional heart surgery aortic valve repair (for aortic regurgitation) or aortic valve replacement (for aortic stenosis or aortic regurgitation)
- minimally invasive aortic valve surgery
- transcatheter aortic valve replacement (known as TAVR or TAVI)for aortic stenosis, TAVR is commercially available
RWJUH is one of the few centers in the US that can perform TAVR for aortic regurgitation as part of the ALIGN-AR JenaValve Clinical Trial
- Aortic valve surgery is safe and highly effective treatment. It can be performed surgical, minimally invasvively or via a catheter-based approach (aka TAVR). Typically, surgical and minimally invasive AVR is recommended for lower-risk patients, while transcatheter aortic valve replacement (TAVR) is generally recommended for higher risk and advanced-age patients.
In order to determine the most appropriate treatment for the patient, a comprehensive evaluation is performed including assessment of the aortic valve, peripheral blood vessels, the aorta, blood vessels in the heart, heart function, lung function, and overall well-being. Typically, this evaluation is completed in a single day.
Treatment Options
Surgical Aortic Valve Replacement (SAVR)
Transcatheter Aortic Valve Replacement (TAVR)
- Make a small incision in the right side of the chest
- Use the heart-lung machine
- Stop the heart
- Cut the old valve and sow in a new valve
- Main part of the procedure < 1 hr and entire procedure ~2 hrs
- A puncture in the groin; no incision
- Don’t stop the heart
- Don’t cut out the native valve
- Put the new valve in the inside the native valve
- Main part of the procedure ~ 30 mins and entire procedure ~1 hrs
Common Patient Characteristics
- Lower Surgical Risk
- Younger Age
- Bicuspid Aortic Valve
- Need for other valve or coronary treatment
Common Patient Characteristics
- Higher Surgical Risk
- Older Age
- Trileaflet Aortic Valve
- Isolated Aortic Stenosis
Primary Benefits
- Safety and efficacy
- Known long term durability
- Discharges typically 3 days
Recovery
- Discharge in ~3 days
- Can expect to return to normal function within a few weeks
Primary Benefits
- Safety and efficacy
- Known long term durability
What are Treatment Options for
Aortic Stenosis?
Surgical Aortic Valve Replacement (SAVR)
- Make a small incision in the right side of the chest
- Use the heart-lung machine
- Stop the heart
- Cut the old valve and sow in a new valve
- Main part of the procedure < 1 hr and entire procedure ~2 hours
Recovery
- Discharge in ~3 days
- Can expect to return to normal function within a few weeks
Primary Benefits
- Safety and efficacy
- Known long term durability
Typical Patient
- Lower Surgical Risk
- Younger Age
- Bicuspid Aortic Valve
- Need for other valve or coronary treatment
Transcatheter Aortic Valve Replacement (TAVR)
- A puncture in the groin; no incision
- Don’t stop the heart
- Don’t cut out the native valve
- Put the new valve in the inside the native valve
- Main part of the procedure ~ 30 mins and entire procedure ~1 hours
Recovery
- ~80% of patients are discharged home the following day
Primary Benefits
- Safety and efficacy
- Faster recovery
Typical Patient
- Higher Surgical Risk
- Advanced Age
- Previous Cardiac Surgery
Frequently Asked Questions about Aortic Valve Disease
Typically patients have no new restrictions after the procedure, and (unless a mechanical valve is placed) there are no new medications that need be taken as a result of receiving the new valve.
Although they vary by patient. The risks of both procedures are death, bleeding, stroke, infection, and vascular injury. In a typical patient the risk of anyone of these complication is less than 1-2%.
Ideally, patients should be treated within 1-3 weeks. Treatment of aortic stenosis is typically not an emergency. However significant delays can pose a risk of heart failure, hospitalization, and sudden cardiac death.
If untreated, 50% of patients with severe aortic stenosis die 18 months years after symptoms are detected. And if untreated ultimately nearly all patients die from this condition within 5 years.
The likelihood of need a valve replaced depends on age at the time of initial surgery (Ann Thor Surg, 2015):
For patients < 60 years, at :
- 10 years, 5.6% (95% CI, 4.7 to 6.8);
- 15 years, 20% (95% CI, 17 to 23); and
- 20 years, 45% (95% CI, 39 to 52)
60 to 80 years old, at:
- 10 years, 1.5% (95% CI, 1.3 to 1.7);
- 15 years, 5.1% (95% CI, 4.4 to 5.8), and
- 20 years, 8.1% (95% CI, 6.7 to 9.7)
- at 80+ years: unlikely
- Transthoracic echo
- Gated cardiac CT
- Pre-admission testing Cardiac catheterization — for some patients
- Cardiac CT can be performed without the need for cardiac cath
Administrative staff will help find a date for treatment Nursing coordinatots will provide instruction on preparation
please call 732-235-7231 or send an email.
Commonly Performed Procedures
Minimally invasive valve surgery is a specialized approach to treating heart valve disease that avoids the need to “crack the chest.” This method uses sophisticated instruments to perform the surgery through a smaller incision at the side of the chest and offers the patients less pain and faster recovery. We perform nearly all of our isolated valve surgeries minimally invasively.
An aortic aneurysm is a bulging, weakened area in the wall of main blood vessel in the body. The risk of aortic catastrophe, including dissection and rupture, increases dramatically with an aneurysm. Surgery may be recommended when the aorta is larger than 4.5-6 cms. Factors including family history, lifestyle, and need for other heart surgery guide decisions about surgery.
An aortic aneurysm is a bulging, weakened area in the wall of main blood vessel in the body. The risk of aortic catastrophe, including dissection and rupture, increases dramatically with an aneurysm. Surgery may be recommended when the aorta is larger than 4.5-6 cms. Factors including family history, lifestyle, and need for other heart surgery guide decisions about surgery.
A “bypass” or “cabg” surgery is the most commonly performed heart surgery. It is necessary when the coronary arteries, which provide blood to the heart become narrow preventing sufficient blood from passing through, and thus depriving the heart of oxygen and nutrients. RWJUH has CABG outcomes that exceed national benchmarks.
When other treatments are insufficient, a heart transplant is a surgical procedure offered to patients with the most severe damage to the heart. RWJUH is one of a limited number of centers in the US that offer advance heart failure surgery, including heart transplant. Dr. Russo has participated in 500+ successful transplant surgeries.
When other treatments are insufficient, a heart transplant is a surgical procedure offered to patients with the most severe damage to the heart. RWJUH is one of a limited number of centers in the US that offer advance heart failure surgery, including heart transplant. Dr. Russo has participated in 500+ successful transplant surgeries.
Clinical Trials at RWJUH
Transcatheter aortic valve replacement vs OMM (randomized) for asymptomatic severe AS The EARLY TAVR trial (Edwards) looks at transcatheter aortic valve replacement (TAVR) as an effective treatment for patients with asymptomatic aortic stenosis. Patients are randomized to either treatment with TAVR or clinical surveillance until the develop symptoms, at which point they are eligible to be treated with TAVR. Read More
This study objective is to establish the safety and effectiveness of the Edwards SAPIEN 3/ SAPIEN 3 Ultra Transcatheter Heart Valve in subjects with moderate, calcific aortic stenosis. Patients are randomized to S3 TAVR device or medical management. Read More
ALIGN-AR evaluates the safety and probable benefit of the transfemoral JenaValve Pericardial TAVR System in patients with symptomatic severe aortic regurgitation. Patients who are high risk for open surgical aortic valve replacement/repair are eligible. RWJUH is one of only 15 centers in the U.S. that can offer this therapy that has been granted a “Breakthrough Device Designation” by the US Food and Drug Administration. This designation is reserved for investigative therapies designed to treat a serious or life-threatening disease or condition and where preliminary clinical evidence indicates that the therapy may demonstrate substantial improvement over existing therapies on one or more clinically significant endpoints, such as substantial treatment effects observed early in clinical development.
Transcatheter aortic valve replacement for severe AS with a novel deviceEvaluates the safety and efficacy of Acurate (Boston Scientific) valve for transcatheter aortic valve replacement. For patients with severe aortic stenosis who are at intermediate or greater risk for SAVR. Patients are randomized to Acurate or commerical TAVR device. Read More
The study is a prospective, multi-center, randomized controlled pivotal clinical trial to evaluate the safety and effectiveness of the EVOQUE System with optimal medical therapy (OMT) compared to OMT alone in the treatment of patients with at least severe tricuspid regurgitation. Subjects will be followed at discharge, 30 days, 3 months, 6 months and annually through 5 years.
This study will establish the safety and effectiveness of the SAPIEN M3 System in subjects with symptomatic, at least 3+ mitral regurgitation (MR) for whom commercially available surgical or transcatheter treatment options are deemed unsuitable.
The SUMMIT-Tendyne trial (Abbott) evaluates the safety and effectiveness of using the Tendyne Mitral Valve System for the treatment of symptomatic mitral regurgitation or mitral annular calcification in patients who are not appropriate for conventional mitral valve surgery. In the randomized arm, patients are treated with either the Tendyne device or MitraClip, while patients in the non-randomized and MAC arms receive the Tendyne device. https://clinicaltrials.gov/ct2/show/NCT03433274
The SUMMIT-Tendyne trial (Abbott) evaluates the safety and effectiveness of using the Tendyne Mitral Valve System for the treatment of symptomatic mitral regurgitation or mitral annular calcification in patients who are not appropriate for conventional mitral valve surgery. In the randomized arm, patients are treated with either the Tendyne device or MitraClip, while patients in the non-randomized and MAC arms receive the Tendyne device. https://clinicaltrials.gov/ct2/show/NCT03433274
CLASP IID/F is a prospective, multicenter, randomized, controlled pivotal trial to evaluate the safety and effectiveness of transcatheter mitral valve repair in patients with degenerative/functional mitral regurgitation with the Edwards PASCAL Transcatheter Valve Repair System compared with the commercially available device (Abbott MitraClip).
RESTORE is a prospective, multicenter, non-randomized trial designed to evaluate the safety and effectiveness of the HARPOON™ Beating Heart Mitral Valve Repair System in patients with severe degenerative mitral regurgitation (DMR).
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Newest heart valve options
Miracle transplant at RWJUH
