Aortic Valve Disease

Aortic Valve DiseaseAortic Stenosis

Aortic stenosis is a narrowing of the aortic valve that limits the flow of blood from the left ventricle to the aorta. Over time, this causes the left ventricle to thicken, since it must work harder to pump blood through the narrowed opening. When the heart is stressed, such as during exercise, the overworked ventricle may not get enough blood. This can lead to chest pain, fainting, and even sudden death. In the long term, the ventricle may start to weaken, eventually causing heart failure.

While aortic stenosis may occur in any age group, most cases of aortic stenosis are seen in people in their 70s or 80s, usually as a result of the natural buildup of calcium in the valve, which gradually increases the valve’s rigidity. A relatively common birth defect called a bicuspid aortic valve, in which there are two leaflets instead of the normal three, can also lead to aortic stenosis. In people with this defect, the valve tends to calcify by the time they reach middle age. Less often, aortic stenosis stems from a case of rheumatic fever during childhood.

Aortic stenosis is readily treatable with valve replacement. There are two types of replacement, mechanical valves and tissue valves. At NYU, the vast majority of valve replacements are done with “third-generation” natural-tissue valves, which have been reengineered in recent years to cause fewer complications and to last longer than previous models. In certain circumstances, it is better for a patient to receive a mechanical valve. Mechanical valves generally do structurally deteriorate, an advantage over natural tissue valves. A major drawback, however, is that the patient must take Coumadin (a blood thinner) for life in order to prevent blood clots.

Most aortic valve replacements at NYU are performed with minimally invasive surgery. The primary advantages are less bleeding, reduced postoperative pain, and shorter recovery times, compared to traditional “open” surgery. Patients generally return to full activities in about three weeks. For older patients, minimally invasive surgery has an additional advantage: a significantly reduced risk of mortality during surgery. Our data, collected on more than 900 patients over age 70, shows that minimally invasive surgery reduces the operative risk in elderly patients by one half, compared to conventional surgical approaches.

Aortic Valve Insufficiency

Aortic insufficiency is a condition in which the aortic valve leaflets do not properly close, resulting in leakage back into the heart. With time, this causes the heart to stretch and enlarge, ultimately resulting in heart failure.

Aortic insufficiency is caused by bicuspid aortic valve (a congenital deformity in which the aortic valve has two cusps rather than three), calcification of the aortic valve (as a result of the natural buildup of calcium in the valve, which gradually increases the valve’s rigidity), aortic valve endocarditis (infection of the valve), or connective tissue disorders including Marfan’s disease and Ehlers Danlos syndrome.

Aortic valve replacement should be performed if a patient is either symptomatic from aortic insufficiency, or if the heart begins to enlarge (based on echocardiogram). In most cases, this operation can be performed using minimally invasive approaches.