Angiology: Open Access
Open Access

Management of Aortic Valve Stenosis: Techniques and Clinical Challenges

Ruth Feldman^{* *}Correspondence: Ruth Feldman, Department of Cardiology and Clinical Medicine, Alzahra University, Tehran, Iran, Email:

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Description

Aortic Valve Stenosis (AVS) is a common and serious heart condition characterized by the narrowing of the aortic valve, which obstructs blood flow from the left ventricle into the aorta and subsequently to the rest of the body. The condition is most commonly caused by age-related calcification of the valve, but it can also result from congenital defects or rheumatic fever. As the valve narrows, the heart has to work harder to pump blood, leading to symptoms like chest pain, shortness of breath, fatigue, and eventually heart failure if untreated.

Conventional management of aortic valve stenosis

In the past, the primary treatment for aortic valve stenosis was surgical intervention, particularly Aortic Valve Replacement (AVR). AVR has long been the standard for patients with symptomatic or severe stenosis, especially in younger, low-risk individuals. However, while AVR is effective, it is not without challenges. For instance, open-heart surgery carries inherent risks, especially for elderly patients and those with comorbid conditions. Additionally, the need for lifelong anticoagulation therapy with mechanical valves and the limited durability of bioprosthetic valves remain important concerns.

Techniques in the management of AVS

Techniques in managing AVS include pharmacological interventions, lifestyle modifications, catheter-based procedures, and surgical options for severe cases.

Transcatheter Aortic Valve Replacement (TAVR): TAVR has revolutionized the treatment of aortic stenosis, particularly for patients who are not candidates for open-heart surgery due to age or other risk factors. The procedure is minimally invasive and involves inserting a catheter through the femoral artery (or occasionally through the chest wall) to deliver a bioprosthetic valve into the heart. Once in place, the new valve expands, pushing the old valve aside and restoring normal blood flow.

Balloon valvuloplasty: For certain patients, especially those who are not suitable candidates for valve replacement, balloon valvuloplasty can be used as a palliative measure. This procedure involves inserting a catheter with a balloon at its tip into the stenotic aortic valve. The balloon is inflated, which dilates the valve and temporarily relieves the obstruction. Balloon valvuloplasty is most commonly used in patients who are not candidates for surgery, such as elderly individuals with limited life expectancy or those who are in poor health.

Surgical valve repair: In some cases, rather than complete replacement, aortic valve repair can be performed, especially if the valve is not severely calcified or damaged. Valve repair is more commonly seen in younger patients with congenital conditions, such as bicuspid aortic valve disease. In these cases, the surgeon may reconstruct the aortic valve to restore its function, potentially preserving the native valve and avoiding the need for prosthetic replacement.

Clinical challenges in aortic valve stenosis management

Despite the advances in treatment, several clinical challenges remain in the management of aortic valve stenosis.

Valve durability and anticoagulation management: For patients undergoing AVR with a mechanical valve, the need for lifelong anticoagulation therapy can be a significant challenge, especially in older adults who are at increased risk of bleeding. Bioprosthetic valves, on the other hand, do not require longterm anticoagulation but have a finite lifespan and may need to be replaced after 10 to 15 years, depending on the patient’s age and health.

TAVR complications and long-term outcomes

While TAVR is a less invasive option compared to open surgery, it is not without risks. Potential complications include vascular injury, stroke, valve malpositioning, and paravalvular leaks. Additionally, long-term outcomes for TAVR remain an area of ongoing research, particularly in younger, low-risk patients.

Diagnosis and monitoring

Accurate diagnosis and assessment of aortic valve stenosis severity are important for determining the appropriate treatment. However, the decision-making process can be complex due to the varying severity of the disease and the potential presence of comorbidities. Diagnostic tools such as echocardiography, CT angiography, and cardiac MRI are essential in evaluating the condition, but there remains a need for more advanced biomarkers and diagnostic methods to better predict disease progression and outcomes.

Conclusion

The management of aortic valve stenosis has seen significant advancements, particularly with the introduction of TAVR and improvements in surgical techniques. These innovations have expanded treatment options, especially for high-risk and elderly patients, and have led to improved clinical outcomes. However, challenges remain, including issues with valve durability, anticoagulation management, and complications associated with TAVR. As the field continues to evolve, future advancements in regenerative medicine, valve technology, and diagnostic techniques provides path for even more effective and modified treatments for aortic valve stenosis, ultimately improving the quality of life and survival for patients.