Aortic valve replacement is the most effective treatment for aortic valve diseases. However, it can place tremendous strain on the body and alternatives procedures may be needed.
The main procedures that may be recommended for people who aren't in good enough overall health to have a conventional aortic valve replacement are outlined below.
Aortic valve balloon valvuloplasty
Aortic valve balloon valvuloplasty involves passing a catheter (a thin plastic tube) through a large blood vessel, into the heart. A balloon is then inflated to open up the aortic valve.
This can help treat a narrowed aortic valve (aortic stenosis), but doesn't help with a leaky aortic valve (aortic regurgitation).
Guidance from the National Institute for Health and Care Excellence (NICE) has recommended that aortic valve balloon valvuloplasty should only be used in people who are not suitable for conventional open surgery. It can also be used as a short-term treatment for babies and children, until they're old enough for valve replacement.
The main drawback with this type of treatment is that the effects may only last for up to a year. After this, further treatment is needed.
Transcatheter aortic valve implantation (TAVI)
Transcatheter aortic valve implantation (TAVI) involves inserting a catheter into a blood vessel in your upper leg or chest and passing it towards your aortic valve. The catheter is then used to guide and fix a replacement valve over the top of the old one.
The main advantages of this technique are that the heart doesn't need to be stopped, so a heart-lung (bypass) machine doesn't need to be used, and it avoids making a large cut (incision) in your chest.
This puts less strain on the body and may mean TAVI is more suitable for people who are too frail to have a conventional valve replacement.
Research suggests the procedure may be as effective as surgery for people in whom surgery would be difficult or risky, and it may result in a faster recovery. But there's little evidence to suggest it's appropriate for people who are suitable for surgery and at a low risk of complications.
Possible complications of TAVI are similar to those of a conventional valve replacement, although the risk of having a stroke after TAVI is higher.
Sutureless aortic valve replacement
Sutureless aortic valve replacement is the newest alternative to traditional open surgery. The main difference between the two procedures is that there are no stitches (sutures) used to secure the replacement valve in place.
The aim of this procedure is to minimise the amount of time the operation takes, so there is less time spent on a bypass machine. It may be an option for people who have a high risk of complications during the standard procedure.
As the procedure is relatively new, the long-term effects are not yet fully known. However, it's thought that the main risks of this treatment are blood leaking around the replacement valve or a blood clot forming.
A leak may mean the procedure has to be repeated to fix the problem, or an alternative treatment may be used. If a blood clot forms, the person could have a stroke.
The aortic valve is the valve that controls the flow of blood out of the left ventricle of the heart, to the aorta (the body’s main artery).
Arteries are blood vessels that carry blood from the heart to the rest of the body.
Blood vessels are the tubes in which blood travels to and from parts of the body. The three main types of blood vessels are veins, arteries and capillaries.