Therapy

The therapy of aortic valve stenosis depends on the severity of the disease, the symptoms that occur as well as any concomitant diseases and the patient’s general condition. While in mild to moderate aortic valve stenosis without symptoms there is controversial discussion as to whether surgical replacement of the aortic valve is justified, surgical procedures for the replacement of the aortic valve in moderate to severe as well as critical aortic valve stenosis are recommended. Surgical procedures are also performed in relatively old patients, as it has been shown that quality of life can be significantly improved by valve replacement even in very old patients.

Aortic valve replacement can be performed using both artificial and biological (porcine) aortic valves. Under certain conditions, new surgical techniques make it possible to insert the new aortic valve minimally invasively with the aid of a catheter via this keyhole technique. Drug therapy is only recommended if surgical treatment is not possible for certain reasons.

Drug therapy for the successful treatment of aortic valve stenosis does not currently exist and, according to the current state of research, is not effective. Studies have shown that the progression of the disease cannot be slowed down by drug therapy. The most important thing is that risk factors are minimized and a lifestyle change is possibly made.

Due to the late diagnosis, however, for most patients surgical therapy is the only way to successfully treat the disease. An exception are patients who, due to other risk factors or concomitant diseases, cannot receive aortic valve replacement or have to wait for surgery. Here, drugs such as diuretics, ACE inhibitors, digoxin, or so-called “Sartane” can be used.

These drugs generally aim to relieve the pumping function of the heart. In order not to jeopardize the success of the therapy, regular check-ups should take place in these cases. According to the current state of research, surgical intervention is the only way to successfully treat aortic valve stenosis.

Depending on the condition of the patient and the conditions of the hospital, different surgical procedures can be considered. Patients who can be expected to undergo surgery due to possible concomitant diseases and their general condition are treated by open surgery. In this open surgery, the old aortic valve is removed and either an artificial or a biological heart valve is sewn into the heart.

It is also possible to insert the heart valve with the help of a catheter. In this procedure, also known as TAVI (transcatheter aortic-valve implantation), the new biological heart valve is guided through an artery in the groin to the aortic valve with the help of a catheter and at this point it is pressed into the old, narrowed valve. Currently, this procedure is only performed on patients for whom open surgery would be too risky.

When operating on aortic valve stenosis, the valve is replaced by a prosthesis. This is indicated when symptoms, especially heart failure, occur. However, even if no symptoms are present, but there is a pressure difference of more than 50 mmHg between the left ventricle and the aorta.

Since life-threatening arrhythmias can also occur here. This topic may also be of interest to you: Artificial heart valvesAn alternative to surgery is a so-called TAVI (Transapical Valve Implantation). In this procedure, the replacement valve is folded up and inserted via catheter through the groin.

Once the old aortic valve has arrived, it is expanded by balloon and the new valve is pressed into place. This procedure is much gentler than surgery, as the chest does not have to be opened and the heart does not have to be stopped. Because it is a relatively new method of aortic valve replacement, there is not yet as much long-term experience as with surgery.

Studies on the durability of the latest generation of valves are also still pending, so that no definitive statement can be made. The last valid guideline, which deals, among other things, with the treatment and diagnosis of aortic valve stenosis, was written by the “European Society of Cardiology“. In the context of the new methods of surgical aortic valve replacement, many experts have dealt with this new guideline, which was published in 2012.

The main components of the guidelines are the indications for which surgical intervention or conservative therapy is recommended, the general conditions that must be given for the performance of the surgical interventions, and contraindications for which the respective therapy should not be performed. The guideline also provides an overview of the study results of individual therapy options. While in Germany the guideline is taken into account in the indication for surgical interventions, individual deviations may be necessary. Since the publication of the guideline, however, the performance of a TAVI (transcatheter aortic-valve implantation) is only possible in certain hospitals equipped for this purpose.