As India’s aging population continues to grow, medical experts are seeing a troubling rise in cases of Aortic Stenosis, a silent but deadly heart condition that primarily affects the elderly. In light of a recent health ministry report highlighting a surge in cardiovascular diseases among senior citizens, Dr. Nikhil Sontakke, Senior Consultant Interventional Cardiologist at Manipal Hospital, Goa, announced the urgent need for increased awareness and timely intervention. Dr. Nikhil Sontakke emphasized that Aortic Stenosis, which often coexists with coronary artery disease, is emerging as a significant public health concern that requires immediate attention.
What is Aortic Stenosis?
Aortic Stenosis is an age-progressive serious cardiac disease caused by the stiffening of the aortic valve that disrupts the normal flow of blood from the heart to the rest of the body. The stiffening of the aortic valve, also known as the calcification of the aortic valve, is a result of the gradual deposit of calcium on the valve leaflets. Aortic Stenosis is also known as a ‘Silent Killer’ as patients do not experience any early symptoms during the onset of this disease.
Cause and Symptoms:
Ageing is one of the biggest causes of Aortic Stenosis and this disease usually affects senior patients aged 65 years and above. Congenital Heart Disease (Bicuspid Aortic Valve), Rheumatic Fever, Radiation Therapy for cancer patients, and Infection in the heart’s inner lining (Endocarditis) are a few causes of Aortic Stenosis.
Senior patients experience varied symptoms like chest pains (angina), fatigue, breathlessness, palpitations, and fainting spells and an immediate medical intervention is required to alleviate symptoms. Severe Aortic Stenosis cannot be managed with medications alone and needs an immediate aortic valve replacement procedure to restore normal valve functionality.
Aortic Stenosis Treatment: SAVR and TAVR
Surgical Aortic Valve Replacement (SAVR), also known as Open Heart Surgery, and Transcatheter Aortic Valve Replacement (TAVR), a minimally invasive treatment are the two options for treating Aortic Stenosis. Open Heart Surgery is usually not recommended for senior patients with comorbidities like Diabetes, Hypertension, Chronic Kidney Disease, Severe Lung Infection, Morbid Obesity, and Sleep Apnea or patients with a history of previous cardiac issues and stroke as they are considered high risk and can experience serious complications intraoperative or post-surgery. A TAVR procedure has been observed to be effective in managing long-term symptoms of Aortic Stenosis.
Transcatheter Aortic Valve Replacement (TAVR), a minimally invasive treatment for severe Aortic Stenosis in senior patients with multiple comorbidities, has proven to be highly effective in improving longevity, and restoring normality of life.
Transcatheter Aortic Valve Replacement (TAVR):
To replace the damaged aortic valve with a biocompatible prosthetic valve, a TAVR procedure is performed in a CATH Lab under local anaesthesia and mild sedation. A small incision is made near the groin region to insert a thin, flexible tube called the catheter. Using advanced imaging technology, the catheter is guided to the damaged valve and a prosthetic valve made of bovine or porcine tissues is placed over the damaged valve using a Balloon Mechanism. The prosthetic valve pushes aside the damaged valve leaflets and immediately takes over the function of regulating the flow of blood from the heart to the rest of the body. The aortic valve replacement procedure takes about 2 to 3 hours.
“TAVR procedure has proven to be effective in treating severe Aortic Stenosis in senior patients with comorbidities by regulating the flow of blood and gradually alleviating the stress on the heart. It’s a globally accepted treatment with over 95% success rate” informs Dr. Nikhil Sontakke.
Hospitalisation and Recovery:
Reduced Complication Rates: Compared to SAVR, TAVR procedures have been observed to have considerably less intraoperative stress and lower rates of post-surgical complications like bleeding, infections or strokes.
Hospitalization: A TAVR procedure requires a 24-hour ICU observation post-surgery and a total hospitalisation period of 4 to 5 days for monitoring valve function and other complications.
Recovery: Clinical evidence on TAVR procedures presents a faster recovery process and patients usually resume their normal routines within a few weeks after the surgery.
Managing Aortic Stenosis:
Cardiac Health: Maintaining cardiovascular health with regular non-strenuous cardiac workouts. Patients should avoid vigorous exercise as it has been observed to aggravate the symptoms of Aortic Stenosis.
Managing Comorbidities: Senior patients with comorbidities should manage blood pressure and cholesterol levels to hinder the progression of Aortic Stenosis.
Managing Obesity: Senior obese patients should exercise lifestyle changes as obesity can lead to the earlier onset of Aortic Stenosis.
Case Study:
A 69-year-old lady with a previous history of open heart surgery for aortic and mitral valve replacements was admitted at Manipal Hospital, Goa with recurrent symptoms of heart failure due to degeneration of the replaced aortic valve. Considering her present symptoms and cardiac history, Dr. Nikhil Sontakke recommended a valve-in-valve TAVR procedure to replace the damaged aortic valve. The patient and her family were educated on the severity of the patient’s condition, the risks associated with a repeat SAVR procedure and how a minimally invasive TAVR procedure would be ideal and effective in replacing the damaged aortic valve. After a 24-hour ICU monitoring and 3 days of hospitalisation, the patient was discharged on the fourth day after an uneventful recovery that showed no signs of vascular complications, stroke or bleeding.
Her 1-month post-surgery follow-up showed significant improvement in symptom alleviation and in her ability to perform daily activities. The echocardiogram showed normal prosthetic valve functioning with no evidence of valve complications and complete recovery from symptoms of heart failure.
