Certainly by now if you are a fan of the Rolling Stones and Mick Jagger, you have learned that it was necessary for the aging rock-n-roll group to postpone its United States No Filter tour. The group’s front man, Mick Jagger, underwent urgent aortic valve replacement surgery.
What is Aortic Stenosis
Mr. Jagger has a condition known as aortic stenosis. The aortic valve is the main valve that controls blood flow from the left ventricle to be pumped to the rest of the body (excluding lungs) is tight or stenotic thereby limiting blood flow to the brain and other organs. Calcification of the valve is the root of the valve becoming stenotic. You can think of corrosion in your plumbing that occludes water from moving through the pipes.
If too little blood makes it through the valve any number of symptoms can occur. These include chest pain, shortness of breath with exertion, or syncope (passing out). It’s unclear from any of the reports that we have seen which of these symptoms Mr. Jagger may have been having.
I have a patient with aortic stenosis who frequently passes out and will be having the same procedure Mr. Jagger had done, the TAVR procedure.
How Common is Aortic Stenosis?
Aortic stenosis is the most common valvular disease in the United States and the second most common cause of cardiac surgery.
How common is aortic stenosis? The incidence of aortic stenosis increases with age. Two point six percent of adults over age 75 (Mr Jagger’s age) have aortic stenosis. In the 50-59 age group only 0.2% of individuals have aortic stenosis. So don’t get old (at least physiologically) – the very reason for this website.
A fairly obvious murmur is frequently detected on examination and the diagnosis is confirmed with a cardiac echogram (ultrasound test) which is a simple non-invasive test.
Aortic stenosis is preceded by aortic sclerosis in which the aortic valve is becoming calcified but not hindering blood flow. Once aortic sclerosis is diagnosed it takes about 6 years for moderate aortic stenosis to develop and 8 years for severe aortic stenosis to occur. Progression of the disease is monitored with periodic cardiac echos.
What is the TAVR Procedure?
The procedure Mr. Jagger underwent is called the TAVR procedure which stands for transcather aortic valve replacement. It is a minimally invasive procedure in which it is not necessary to crack open the chest through the sternum. The recovery is much faster than the traditional open heart surgery to replace cardiac valves.
The recovery from the TAVR procedure is about 3 to 5 days. The recovery from open heart valve replacement includes a week in the hospital and several months of convalescence and cardiac rehab. Plus, the are far more potential complications from open heart surgery.
TAVR is a safer option in older patients who many times have other chronic diseases that place them at increased risk for traditional open heart surgery.
How the TAVR Procedure Works
A collapsible replacement valve is delivered to the valve site in the heart by way of catheter either by entering the femoral artery (groin) or through a small incision in the chest and entering through a large artery.
In the TAVR procedure the old or damaged aortic valve is not removed. Instead it is used to help position and anchor the new valve. The catheter is used to wedge the new valve within the old valve – so it’s a valve within a valve.
Once in position the new valve is expanded pushing the old valve leaflets out of the way. The new valve is now ready to take over regulating blood flow.
The animation below nicely shows how the TAVR procedure is performed
How Safe and Effective is the TAVR Procedure?
A recent 24 month study concluded that in intermediate risk patients, the results of the TAVR procedure was comparable to surgical replacement in terms of deaths and strokes.
The mortality rate for the TAVR procedure is 2% to 3%. Though primarily performed on intemediate to high risk patients TAVR has been shown safe in low risk patients as well based on this study
This review states that in terms of clinical outcomes TAVR is comparable or superior to surgical aortic valve replacement.