Our Summary

The study looked at surgical procedures to replace damaged aortic valves in the heart, known as Transcatheter Aortic Valve Replacements (TAVR). These procedures can be more difficult in patients who have a bicuspid aortic valve (BAV) - meaning their aortic valve only has two leaflets or flaps, instead of the typical three (TAV). BAV patients have previously been excluded from large clinical trials relating to this type of surgery.

The research team examined data from TAVR procedures carried out between 2011 and 2014. They looked at things like patient death rates while in the hospital, complications during the procedure, the length of hospital stay, and the cost of the treatment.

Out of over 40,000 TAVR procedures identified, 1% were performed on BAV patients and the rest on TAV patients. The BAV patients were younger and generally had fewer other health problems.

The researchers found that outcomes such as death rates, complications, and the need for a permanent pacemaker were similar between the two groups.

They concluded that with advancements in imaging and technology, TAVR can successfully be performed on BAV patients, and these patients should not be excluded from the procedure. However, more extensive studies are needed.

FAQs

  1. What is a Transcatheter Aortic Valve Replacement (TAVR)?
  2. What is the difference between a bicuspid aortic valve (BAV) and a typical aortic valve (TAV)?
  3. How is the success rate of TAVR procedures in BAV patients compared to TAV patients according to the study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about aortic valve replacement is to discuss with their healthcare provider the possibility of Transcatheter Aortic Valve Replacement (TAVR) if they have a bicuspid aortic valve (BAV). Advancements in imaging and technology have shown that TAVR can be successfully performed on BAV patients, so it is important to explore all treatment options with your doctor.

Suitable For

Patients who are typically recommended aortic valve replacement include those with severe aortic stenosis, aortic regurgitation, or other conditions that affect the function of the aortic valve. These patients may experience symptoms such as chest pain, shortness of breath, fatigue, dizziness, or fainting. Aortic valve replacement may also be recommended for patients with aortic valve defects, congenital heart conditions, or previous heart surgeries that have resulted in a damaged or dysfunctional aortic valve. Ultimately, the decision to undergo aortic valve replacement will depend on the individual patient’s overall health, age, and specific heart condition.

Timeline

Before aortic valve replacement:

  • Patient experiences symptoms of aortic valve stenosis or regurgitation, such as chest pain, shortness of breath, fatigue, and dizziness.
  • Patient undergoes various diagnostic tests, including echocardiograms, cardiac catheterization, and imaging studies, to determine the severity of the valve disease.
  • Patient and healthcare team discuss treatment options, including TAVR for high-risk patients or traditional open-heart surgery for low-risk patients.
  • Patient undergoes pre-operative evaluations and preparations, including blood tests, imaging studies, and consultations with anesthesia and surgical teams.

After aortic valve replacement:

  • Patient undergoes the TAVR procedure, which involves inserting a new valve through a catheter into the heart, typically through a small incision in the groin or chest.
  • Patient is monitored closely in the hospital post-procedure for complications, such as bleeding, infection, or heart rhythm abnormalities.
  • Patient may require a temporary pacemaker to regulate heart rhythm during the recovery period.
  • Patient undergoes cardiac rehabilitation to regain strength and endurance post-surgery.
  • Patient is followed up regularly by healthcare providers to monitor valve function, manage medications, and address any complications or concerns.

What to Ask Your Doctor

Some questions a patient should ask their doctor about aortic valve replacement, especially if they have a bicuspid aortic valve, include:

  1. What are the potential risks and complications associated with aortic valve replacement, particularly for patients with a bicuspid aortic valve?
  2. How experienced is the medical team in performing TAVR procedures on patients with bicuspid aortic valves?
  3. Will I need a permanent pacemaker following the procedure?
  4. What is the expected recovery time and rehabilitation process after aortic valve replacement?
  5. Are there any alternative treatment options available for patients with a bicuspid aortic valve?
  6. How will my overall health and any other medical conditions I have impact the success of the procedure?
  7. What are the long-term outcomes and prognosis for patients with a bicuspid aortic valve who undergo aortic valve replacement?
  8. Will I need follow-up appointments and monitoring after the procedure, and if so, how often?
  9. What is the cost associated with aortic valve replacement, and will my insurance cover the procedure?
  10. Are there any lifestyle changes or precautions I should take after aortic valve replacement to maintain heart health?

Reference

Authors: Nagaraja V, Suh W, Fischman DL, Banning A, Martinez SC, Potts J, Kwok CS, Ratib K, Nolan J, Bagur R, Mamas MA. Journal: Cardiovasc Revasc Med. 2019 Jan;20(1):50-56. doi: 10.1016/j.carrev.2018.09.013. Epub 2018 Sep 18. PMID: 30287215