Aortic Stenosis

Overview of Aortic Valve Stenosis

Read our comprehensive resources for more information on this condition, including symptoms and treatments of aortic stenosis patients.

What is Aortic Stenosis?

Complications

When not managed closely, complications include:

• Congestive heart failure

• Hypertension-mediated cardiovascular (CV) damage

• Death

How Aortic Stenosis Is Diagnosed

Aortic stenosis is often first suspected when a doctor hears a heart murmur during a routine check-up. 

Aortic Stenosis Causes

The most common cause of aortic stenosis is degenerative disease, where the valve becomes stiffer and narrower with age. Age-related degenerative aortic stenosis is rising and is expected to become even more common as the population continues to age.

Other causes include:

• Congenitally abnormal valves: The most common is a bicuspid aortic valve (two flaps instead of three). Approximately 0.5–1% of children are born with this condition. People with bicuspid valves tend to develop narrowing earlier than those with standard tricuspid aortic valves.
• Systemic inflammatory diseases: Most often, rheumatic heart disease. This is caused by rheumatic fever in childhood, though it has become much less common today.
• Infections and other conditions: Such as infective endocarditis.

Risk Factors

Age is one of the most important risk factors of AS. It affects about 2–3% of people over the age of 65. A well as:

• Chronic kidney disease
• Radiation therapy history

While heart risk factors are common in people with AS, they do not seem to cause AS itself. These factors include:

• Men are at high risk.
• Hypertension (high blood pressure)
• Hypercholesterolaemia
• Smoking
• Diabetes mellitus
• Family history of coronary artery disease

Aortic Stenosis Symptoms

There is a range of symptoms related to aortic stenosis. Milder forms of aortic stenosis produce very few symptoms.

Patients with symptomatic aortic stenosis may experience:

• Dyspnea (breathlessness)
• Syncope (fainting episodes) and
• Angina (chest pain)

Aortic Stenosis Treatments in London

There are various aortic valve stenosis treatment options in London available to you.

Note: While there is no cardiovascular medicine that can reverse aortic stenosis, medical management plays a vital role in symptom control and managing comorbidities (multiple conditions present).

Aortic Stenosis Surgery

Both the European and American heart societies’ guidelines recommend aortic heart valve replacement (AVR) surgery for severe aortic valve stenosis.

AVR is an effective treatment and will improve your quality of life. The surgery carries a low risk of less than 1% for a healthy 70-year-old. AVR may even be considered for patients with asymptomatic aortic stenosis who are at higher risk of sudden complications.

Please find below some diagrams showing the different types of aortic stenosis surgery available, and the different benefits and disadvantages of each:

Sternotomy

• Full breastbone division
• 12 weeks to heal

Ministernotomy

• Less pain / Bleeding
• Better breathing
• Less infection

Anterior Right

• Thoracotomy
• No broken bone
• Heals in 7 to 10 days
• Less pain/bleeding
• Better breathing
• Less infection

Keyhole Aortic Valve Stenosis Surgery London

Surgery,  such as aortic valve replacement, can be performed through keyhole incisions that either divide only a very small portion of the breastbone. In some cases, one can avoid breastbone division altogether.

The advantages of keyhole heart surgery are:

• Minimally invasive surgery
• Quicker healing
• Improved breathing
• Fewer bleeding complications and swifter discharge from the hospital.
• Improved cosmetic look of the incision.

We would always recommend a keyhole approach to surgery for aortic stenosis patients where it is applicable. However, as it is not suitable for every type of patient, your doctor will advise the best course of action for you.

Transcatheter Aortic Valve Implantation (TAVI)

In high-risk aortic stenosis patients, an alternative treatment called Transfemoral Aortic Valve Implantation (TAVI) can be used as a way to offer some relief without the need for surgery. However, the results are not as good in the long term, so we would only offer this to very high-risk patients.

The ongoing limitation of TAVI is the risk of leaks around the edge of the new valve, the high incidence of pacemaker requirement, and the lack of long-term durability of TAVI valves, which make them unsuitable for patients who need a good result beyond 3 to 5 years.

The best treatment is still surgical replacement.

Sutureless AVR

These valves are essentially the same as traditional tissue valves, and we believe that the long-term durability of the prosthesis is excellent. The advantage of these valves lies in the fact that they can be deployed very swiftly.

This makes them very suitable for patients who need a swift operation to reduce the risk of the surgery. They also facilitate minimally invasive AVR procedures because of their ease and speed of deployment.

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Keyhole Heart Clinic: Expert Treatment for Aortic Stenosis

The next generation of heart surgery can be part of your treatment plan at The Keyhole Heart Clinic. Our clinic is led by Mr. Inderpaul Birdi, a cardiothoracic surgeon with over twenty years of experience in keyhole cardiac procedures.

These include:

• Keyhole coronary bypass surgery
• Keyhole mitral valve repair or replacement surgery
• Keyhole tricuspid valve replacement
• Keyhole aortic valve replacement
• Keyhole atrial fibrillation ablation
• Keyhole atrial septal defect closure

We also offer comprehensive heart screening services.

Consult with leading heart specialist Mr Inder Birdi about your options, like keyhole surgery, for aortic stenosis. Schedule your appointment at our London heart clinic or via Zoom.