The Facts About Valve Disease
Heart valve disease is a public health crisis that affects as many as 5 million Americans. It’s crucial that you recognize the risks and symptoms and seek treatment when necessary.
The good news: by detecting heart valve disease early, people can get the treatment they need to live healthier and happier lives.
Fact: some symptoms aren't just a sign of aging
- More than 5 million Americans are living with heart valve disease, which can cause heart attacks, arrhythmias, congestive heart failure and other heart conditions.
- Many people who have heart valve disease are not aware of it, either because they have no symptoms or because they assume the lack of energy they experience is just part of aging.
- Heart valve disease can significantly impact quality of life and is life-threatening if not treated.
- If heart valve disease goes undetected, it can impact the heart’s ability to pump blood, which requires repair or replacement.
Chris Jackson is a breast cancer survivor. After several rounds of chemo and open-heart surgery, she was left with tricuspid regurgitation. Dr. Paul Sorajja at the Minneapolis Heart Institute Foundation introduced Chris to the Triluminate trial, which is a tricuspid valve clip and a less-invasive option to fix her leaky valve.
What is Heart Valve Disease?
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Healthy heart valves open and close to keep blood flowing through your heart in the right direction. Blood flow is important because blood carries oxygen and nutrients to all parts of your body.
Heart valve disease occurs when the heart valves do not work properly. They may be too stiff and narrow to open fully, which is called stenosis. Or, the blood may be leaking backward through the heart valves, which is called regurgitation. This can lead to heart failure.
Once the heart valve begins to affect the heart’s ability to pump blood, it’s likely to require repair or replacement. Without treatment, those diagnosed with severe, symptomatic heart valve disease may have an average survival of only one to two years. The good news is that today, research is ongoing to advance new technologies and procedures that offer a minimally invasive treatment option.
MHIF has research going on across all areas of heart valve care and treatment. Make sure you ask your physician about all the treatment options available to you, including through research. Some new technologies may only be available through a research study.
Highlight: Aortic Stenosis
Aortic stenosis (AS) is a heart condition that occurs when the aortic valve narrows, preventing it from properly opening and closing, and diminishing blood flow between the heart and the rest of the body. The reduced blood flow increases pressure within the heart, causing the heart to weaken and function poorly. When AS becomes severe and symptoms develop, it is life-threatening. As many as 50% of AS patients with severe symptoms may die within one year without appropriate treatment.
AS primarily affects older people and occurs at higher rates in men than in women. It is the second most common heart valve problem in the U.S. As many as 12.4% of people aged 65 and older currently suffer from AS, and the rate is expected to more than double for high income countries by 2050. More than two million patients live with moderate aortic stenosis in the U.S., which represents more than two times the population of patients with severe aortic stenosis.
Causes & Symptoms
The most common cause of aortic stenosis is excessive wear on the aortic valve. This usually develops with age, but the process may be expedited in patients who are congenitally predisposed to disease.
Calcium buildup can also expedite the development of AS by stiffening the valve and limiting movement. These calcium deposits, which originate from the blood’s calcium supply as it flows through the aorta, accumulate over many years and are therefore more common in elderly patients.
Rheumatic fever can also cause aortic stenosis by producing scar tissue on the aortic valve and forcing the aortic valve to narrow. Rheumatic fever, though rare in developed countries, arises from complications of scarlet fever or strep throat. AS can take years to manifest in patients who have had rheumatic fever.
Symptoms include:
- Fatigue
- Dizziness
- Chest pain/pressure
- Heart murmur
- Shortness of breath during activity
- Heart palpitations
- Fainting
Treatment
Treatment for patients diagnosed with AS is typically managed by a team of experienced cardiologists, cardiac surgeons and other medical specialists who collaborate to determine the most appropriate care for each patient. Medications are sometimes prescribed to help control symptoms, maximize heart function, control blood pressure and control heart rhythm disturbance. Today, those who have moderate, symptomatic AS undergo periodic monitoring with transthoracic echocardiography every one to two years (or with any change in symptoms or findings).
Patients who suffer from severe, symptomatic AS often receive a minimally invasive, catheter-based procedure known as transcatheter aortic valve replacement (TAVR) to replace and reopen their aortic valve. TAVR is less invasive than open-heart surgery, and the procedure typically takes less than one hour. During a TAVR procedure, a physician guides a thin, flexible tube with the heart valve into a patient’s artery and the diseased valve. Then the TAVR heart valve is placed in the disease valve and the physician removes the tube and closes the cut. Throughout the procedure, the physician views images of the patient’s heart.
After the TAVR procedure, most patients spend a few hours in the intensive care unit before being transferred back to their hospital room. Patients typically begin walking the same day as their TAVR procedure, are discharged within one to two days and can care for themselves and resume everyday activities. Before patients leave the hospital, their physician explains what types of physical activity they are permitted to do, what types of medications they need to take and when they will need to return for medical reevaluation, typically 30 days and one year after the procedure and as recommended by the physician. Most patients start feeling better immediately following a TAVR procedure and report having more energy, breathing normally, experiencing less pain and fewer symptoms, and feeling less anxious.
Current Valve Disease Studies at MHIF
PROGRESS: Management of Moderate Aortic Stenosis by Clinical Surveillance or TAVR
Brief Summary:
This study objective is to establish the safety and effectiveness of the Edwards SAPIEN 3/ SAPIEN 3 Ultra Transcatheter Heart Valve in subjects with moderate, calcific aortic stenosis.
Key Inclusion Criteria:
- 65 years of age or older at time of randomization
- Moderate aortic stenosis
- Subject has symptoms or evidence of cardiac damage/dysfunction
- The subject or subject's legal representative has been informed of the nature of the study, agrees to its provisions, and has provided written informed consent.
Evolut™ EXPAND TAVR II Pivotal Trial
Brief Summary:
Obtain safety and effectiveness data to support indication expansion for the Medtronic TAVR System to include patients with moderate, symptomatic AS.
Key Inclusion Criteria:
Moderate AS, defined as follows by transthoracic echo (TTE) at rest:
- Max aortic velocity ≥ 3.0 m/sec and < 4.0 m/sec, and
- Mean aortic gradient ≥ 20.0 mmHg and < 40.0 mmHg, and
- AVA >1.0 cm2 and < 1.5 cm2
NYHA class ≥ II and symptoms of AS, including but not limited to:
- Dyspnea at rest or on exertion
- Fatigue
- Angina
- Syncope in the absence of another identifiable cause
LVEF > 20% by 2-D echo
Any of the following
- HF event or hospitalization for heart failure within 1 calendar year prior to qualifying echo
- NT proBNP ≥ 600 pg/ml (or BNP 80 pg/ml) measured within 6 months prior to or within 2 weeks after qualifying echo,
- Global longitudinal strain ≤15% (absolute value) at qualifying echo, or
- E/e' (average of medial and lateral velocities) ≥ 14.0 at qualifying echo
Research & Education at the Valve Science Center
Our current research is focused on advancing treatment options before symptoms become debilitating. To spread awareness about heart valve disease, MHIF hosts yearly Valve Awareness Day events, focused on teaching our community about:
- The public health epidemic of heart valve disease
- The latest in heart valve disease research and treatments
- Sharing inspiring stories of life after heart valve disease treatment
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