By Dr. Jorge Palazuelos, Head of the Hemodynamics Unit at UICAR
Heart valve disease is a growing problem, especially in aging populations. Its prevalence varies depending on the affected valve and the cause of the disease. Valve involvement can manifest as stenosis (opening problems) and/or insufficiency (closing problems).
Risk factors that predispose to its alteration include advanced age (the main cause of valve degeneration), congenital diseases (such as bicuspid aortic valve), rheumatic fever (especially relevant in developing countries), and hypertension and cardiovascular diseases, which contribute to mitral and aortic regurgitation.
The most common valvular disease is aortic stenosis. In its degenerative form, secondary to aging and the presence of cardiovascular risk factors (such as high blood pressure, diabetes mellitus, high cholesterol, etc.), it affects 2–7% of people over 65 years of age and up to 12% of those over 75. Its congenital form (bicuspid valve) is estimated to occur in 1–2% of the population. This predisposes to a higher risk of stenosis at an early age.
Mitral regurgitation is the most common valve disease in adults. Its prevalence is 2-3% in the general population and increases with age (6-9% in those over 65 years of age).
With the aging of the population, the prevalence of aortic stenosis and mitral regurgitation is expected to increase significantly.
Other valvular diseases include aortic insufficiency (affecting 0.5–2% of the population and associated with aortic dilatation, connective tissue diseases, and rheumatic fever); mitral stenosis (affecting 1–2% of the adult population, mainly of rheumatic origin; it remains common in developing countries). Tricuspid and pulmonary valve diseases are less common, although significant tricuspid insufficiency may affect up to 1.5% of the population over 70 years of age.
Transcatheter aortic valve replacement ( TAVR ) has revolutionized the treatment of valvular heart disease, especially in patients at high surgical risk. Currently, the percutaneous approach to valvular pathologies is the first-line treatment for most patients. However, the best option in each case should be evaluated individually.
Its main benefits include:
1. Less invasive: They are implanted through catheterization, avoiding open heart surgery.
2. Faster recovery: Less hospitalization time and faster return to everyday life.
3. Lower risk of surgical complications: Reduces mortality and complications such as infections, postoperative heart failure, stroke, or kidney failure.
4. Alternative for inoperable patients: Benefits people with high surgical risk or contraindication for surgery.
5. Results comparable to surgery: In certain groups of patients, the results in terms of clinical improvement and survival are equivalent to or superior to conventional surgery.
6. Less need for general anesthesia: In many cases, local anesthesia or sedation is used, reducing risks in fragile patients.
Percutaneous valves are ideal for:
1. Patients with high or prohibitive surgical risk: People with advanced heart disease, advanced age (>75-80 years), or comorbidities (COPD, kidney failure, frailty) that make open heart surgery difficult.
2. Severe symptomatic aortic stenosis: especially in those with dyspnea, angina or syncope who cannot undergo conventional valve replacement surgery.
3. Patients previously treated with surgical biological valves that have deteriorated: it can be used for “valve-in-valve” surgery, avoiding a second surgery in patients who already have a bioprosthetic valve.
4. Selected low-risk cases, as recent studies suggest that these patients may also benefit from surgery, as there are no significant differences.
Other aspect
Another important aspect for patients is that, in addition to being safe and effective procedures, less invasive than conventional surgery, their recovery after the TAVI/TAVR procedure is much faster than with conventional surgery:
• Hospitalization time: Generally 2-3 days (versus 7-10 days in open surgery).
• Early mobilization: Patients can walk the same day or the next day.
• Minimal pain and discomfort: The sternum is not opened, which reduces postoperative pain.
• Return to normal activities: In 1-2 weeks, depending on the patient's general condition.
• Postoperative medication: Generally anticoagulation or antiplatelet therapy to prevent blood clots.