An artificial valve hold hope for those with Aortic Stenosis

TAVI may be an option for people who can't have heart surgery to replace the aortic valve as it can help reduce chest pain, shortness of breath, and other symptoms of Aortic Stenosis, writes Dr Jayaranganath.

Cardiovascular disease (CVD) remains the foremost cause of death and disability worldwide, taking a staggering toll of 17.9 million lives each year, which accounts for approximately 31% of all global deaths. More alarmingly, over 75% of these fatalities occur in low and middle-income countries, posing a significant health challenge.

The heart valves play a crucial role in regulating the flow of blood into and out of the heart. Valvular heart disease is a common form of cardiovascular disease that primarily affects the heart's valves.

The damaged heart valve either restricts the flow of blood (stenosis) or the pumped blood is leaked back into the same heart chamber (regurgitation). Aortic Stenosis (AS) is a degenerative valvular heart disease primarily affecting the elderly. It is a condition where the aortic valve narrows down, restricting the flow of blood into the aorta, an artery that carries blood from the heart to other circulatory systems. With a very low survival rate of just 18% after five years without treatment, it's incredibly important to find effective alternative treatments.

Transformation in treatment modalities for AS

While medications can help manage symptoms associated with Aortic Stenosis, they do not offer a cure. On the other hand, surgery stands as the sole effective treatment for severe aortic stenosis (AS). Historically, surgical aortic valve replacement (SAVR) an open-heart surgery, stood as the gold standard for AS treatment. Gradually, transcatheter aortic valve implantation (TAVI), a minimally

invasive procedure served as an alternative for patients with maximum surgical risk and the elderly.

In minimally invasive surgery, a smaller incision in the chest or groin is made and a catheter is used to replace the faulty valve. Data indicates the potential benefits of TAVI in young low-risk patients as well as elderly patients. 70% of low-risk aortic stenosis patients treated with either TAVI or SAVR can expect to be alive and symptom-free.

TAVI's emergence as a viable, and sometimes superior alternative to SAVR presents several tangible advantages. Firstly, it offers a less invasive procedure for patients, potentially reducing hospitalisation time and post-operative recovery periods. This approach has not only made treatment more accessible to a broader range of patients but also holds the potential to alleviate the burden on healthcare facilities by providing an effective outpatient option.

Ongoing research and collaboration will be crucial to maximise the benefits of TAVI while refining patient selection criteria and optimising the procedure.

The author is a senior consultant cardiologist (paediatrics & adults).