Harvard Heart Letter

Aortic valve disease: Surgical or transcatheter replacement?

Each technique works for appropriate people.

Some 1.5 million Americans, most ages 75 or older, have aortic valve stenosis: a stiffening of the valve that must open to let blood surge from the heart to the body. As the valve degenerates, blood flow slows. Daily activities become difficult or impossible. Symptoms include fainting and chest pain. Unless the valve is replaced, half the people with symptoms die within two years.

Fortunately, surgeons learned decades ago how to replace the aortic valve. Modern surgical replacements use a mechanical valve or a bioprosthetic valve made with animal tissue attached to synthetic materials. Yet surgical aortic valve replacement (SAVR) still means open-heart surgery, several days in the hospital, and four to six weeks of recovery at home. Especially for older patients, this can be very risky, says Dr. Fred Welt, assistant professor of cardiology at Harvard Medical School and Brigham and Women's Hospital.

"Valve replacement with cardiac surgery has been very effective, but a lot of patients are not able to withstand the surgery," he says. "That was the impetus of looking at other ways of implanting valves."

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