1. Aortic Valve Disease and Trans-catheter Aortic Valve Replacement “The Latest Treatment Option”
Sonia Scalf, RN, CVSN
Structural Heat Nurse Coordinator Vanderbilt Heart and Vascular Institute

2. Aortic Stenosis
Aortic stenosis is the most important cardiac valve disease in developed countries, affecting 3 percent of persons older than 65 years.
Aortic valve replacement is the only effective treatment for patients with severe symptomatic aortic stenosis.

3. What is Aortic Stenosis?
Aortic stenosis: is a buildup of calcium deposits in the valve, which causes it to narrow and reduce blood flow to the rest of your body.

4. Types of Aortic Stenosis

5. Aortic Stenosis is Progressive
Mild to severe symptoms
Asymptomatic
Mild symptoms
Healthy
Mild
Severe
Moderate

6. What are the Symptoms of Aortic Stenosis?
Symptoms of aortic valve disease are commonly misunderstood by patients as normal signs of aging.
Most Common Symptoms
Shortness of breath
Fatigue
Difficulty walking short distances
Dizziness or passing out
Swollen ankles, feet and legs
Chest Pain
Lack of motivation to participate
Fast heartbeat
What are the Symptoms of Aortic Stenosis?

7. What’s the big deal? 80 year olds are supposed to be tired, right?
Once symptoms occur, the prognosis of severe AS is dismal, with survival rates of only 15% to 50% at 5 years. Despite this, The European Heart Survey on Valvular Heart disease found that a full third of people who needed surgery didn’t receive this. Most like this is due to age and multiple medical (and/or psychiatric) co-morbidities. Its worth mentioning that this chart is taken from Braunwald who was seeing mainly rheumatic aortic stenosis. We are mainly seeing calcific AS, especially in our older patients, and the latent period is perhaps not as long.
Blase A Carabello, Walter J Paulus Lancet 2009; 373: 956–66

8. Said another way… 5-Year Survival8 Survival, % Breast Cancer Lung
Colorectal
Prostate
Ovarian
Severe
Inoperable AS*
Survival, %

9. The Prevalence of Aortic Stenosis Increases with Age
This is a disease of the elderly, and the frequency of severe aortic stenosis increases with age. For people over the age of 75 in the US, about 3% have severe AS, and about 12.5% has moderate or severe AS. As the population of patients over the age of 75 increases in the US (baby boomers) you can imagine that the numbers will go up dramatically.
Nkomo et al. Lancet 2006; 368: 1005–11

10. How Do You Get Diagnosed?
Echocardiography (ECHO)
How often should you have an ECHO
An echocardiogram (echo) can confirm your symptoms and tell how severe your stenosis.
It's also an important test to help monitor aortic valve stenosis over time.
Mild Every to 5 years
Moderate Every 1 to 2 years
Severe Every 6 to 12
How Do You Get Diagnosed?

11. Other Test to Diagnose Aortic Stenosis
Auscultation
A stethoscope is used to listen to te sounds of your heart which may detect a murmur
Chest X-Ray
An x-ray of your chest can reveal calcium deposits on your aortic valve
Cardiac Catheterization
This is a test where dye is injected in your heart through your arm or groin and measurements are taken across the aortic valve
CT scans/MRI
This is imagig that can show how calcified the aortic valve leaflets are

12. The Heart Valve Team
It takes a specialized and dedicated team to decide which treatment option is right for you

13. Which Is Best For You? Surgical Aortic Valve Replacement (SAVR)
Transcathter Aortic Valve Replacement (TAVR)
Which Is Best For You?

14. Surgical Aortic Valve Replacement (SAVR)
Typically requires incision across the full length of the breast bone
Requires heart lung machine
Disease aortic valve is completely removed
Typically associated with longer hospital stay and longer recovery

15. Trans-cather Aortic Valve Replacement (TAVR)
Catheter based technique that is performed while the heart is still beating
May be a better alternative for those who are at intermediate risk for open heart surgery
Typically associated with shorter hospital stay and recovery time

16. TAVR Patients Suffer Less Repeat Hospitalization

17. Edwards Sapien Valve

18. How is TAVR Performed?
Trans-femoral is the most common approach (access via upper leg, groin area)
An alternative access approach is available for patients with vascular access issues

19. TAVR Procedure

20. Who is Eligible for TAVR
*People with symptomatic severe aortic stenosis who are intermediate risks are greater risks for mortality for open heart surgery as determined by a specialized heart team

22. TAVR Evaluation: What to Expect
Initial contact with the TAVR nurse coordinator. This person who will be with you before during and after surgery
This person will explain the process and be easily accessible to you and your family

23. TAVR Evaluation Process
Interventional Cardiologist in clinic
Two Separate clinic visits with Cardiac surgeons
Echocardiogram (may or may not need to be repeated)
Pulmonary function tests
Frailty tests
Carotid ultrasound
Dental exam
CT angiogram of chest abdomen and pelvis
Cardiac catheterization
Lab work
Electrocardiogram

24. Valve Class: Preparation for surgery
One on one or small group pre op TAVR class
TAVR coordinator/educator
Valve biinder: What to expect pre and post op including at home
What medications to hold and how long to hold them
Antibacterial scrubs
Answer any last minute questions or concerns

25. Support System: Before and After
Patient and family support
Education from heart team
Teaching from heart team
Social worker
Cardiac rehab
Community support
Mended Hearts – make sure family and patient aware of support group
Out-patient cardiac rehab

26. Working Together to Improve the Quality of Life