Aortic Valve Disease

Aortic Valve Stenosis

Aortic valve stenosis occurs when the opening of the aortic valve becomes narrowed and the valve no longer opens fully with each heartbeat. The aortic valve is located between the left ventricle of the heart and the aorta, the largest artery in the body. Aortic stenosis becomes increasingly common with age, predominantly affecting those over the age of 65. When symptoms, such as shortness of breath or chest pain, develop from aortic stenosis, the average life expectancy is only 1-2 years, with a prognosis that is worse than most cancers if left untreated. Unfortunately, at least 1/3 of patients with aortic valve stenosis today are not receiving valve replacement, which is the only treatment that is effective for this condition. This is because many patients who have severe aortic valve stenosis might be too frail or too ill for conventional open-heart surgery.

Transcatheter Aortic Valve Replacement (TAVR)

Figure 1: Transcatheter aortic valve replacement (TAVR) using a transfemoral approach to the aortic valve. Image by Edwards Lifesciences ™ LLC, Irvine, CA

Transcatheter aortic valve replacement (TAVR) provides a treatment option for many patients who previously had no other options or are at moderate to high risk for conventional open heart surgery. Severe symptomatic aortic stenosis is a life threatening condition. Often, patients with this condition are high risk for standard open surgical valve replacement.With TAVR, physicians now have the ability to provide aortic valve replacement via minimally-invasive approaches, including percutaneous procedures (intervention without an incision), which provide outcomes that are as good, or sometimes better than, surgical valve replacement. Instead of opening the chest to reach the heart, the physicians use small tubes, or catheters, to thread very small surgical tools to reach the heart. See Figure 1 and Figure 2. TAVR is a Transcatheter Aortic Valve Replacement that is less invasive than standard valve replacement and allows for quicker recovery time as well.

TAVR procedure, by definition, is multidisciplinary. Patients benefit greatly when they can be evaluated by a multidisciplinary team, who then together decide on the best treatment option and provide the highest level of care. Patients are seen in our Valve Clinic by an interventional cardiologist, a cardiothoracic surgeon, a nurse practitioner and a nurse coordinator in order to provide seamless, convenient, and comprehensive care. Patients are then reviewed at a weekly multidisciplinary team meeting to finalize treatment plans with input from the referring and/or primary care physician. By pooling knowledge, expertise, and resources, all options are evaluated, allowing the physicians in the UNC Valve Clinic to provide the best patient care.

Watch our YouTube videos about TAVR procedures at UNC.

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UNC Surgery

When traditional open heart surgery is needed for your aortic valve, you want a team of surgeons who offer the highest level of care and the most treatment options. There are many decisions that need to be made (repair vs. replacement; mechanical valve vs. tissue valve). Our team of surgeons provides all treatment options and will work with you to find the option that best meets your needs.

Mitral Valve Disease

Mitral Regurgitation

Mitral regurgitation occurs when there is a backflow of blood between two of your heart chambers. This blood “leaks” from the left ventricle back into the left atrium. This causes extra work for the heart and lungs.

MitraClip

At UNC we are now able to offer a less invasive procedure that decreases the backflow of blood and repairs the mitral valve. The MitraClip procedure is used for patients that are high risk or not candidates for open-heart surgery.

When surgery is needed for your mitral valve, you want an expert team that offers the highest likelihood of mitral valve repair to restore the natural function of your own mitral valve. Our cardiac surgeons provide the highest level of care with outstanding results at mitral valve repair.

Congenital Heart Disease

Atrial septal defect closure

An atrial septal defect is a hole in the heart between the two upper chambers of the heart. This is one of the most common congenital heart defects. For many patients, this hole can be closed minimally invasively by passing a closure device though blood vessels in the groin up into the heart. The recovery after this procedure is usually under 24 hours.

Patent foramen ovale closure

A patent foramen ovale is present in up to 25% of the general population. In rare cases, a large PFO can cause problems because it allows too much blood flow to mix from the deoxygenated side to the oxygenate side. In other cases, it can be implicated as a cause for stroke. Closure of a PFO is currently an off-label procedure, but can be appropriate in select cases. This procedure is done in a similar fashion to the atrial septal defect closure.

Ventricular septal defect closure

A ventricular septal defect is a hole between the two lower chambers of the heart. These can be congenital or acquired. UNC is one of the few centers in the area that offer a percutaneous approach to closing these holes.

Patent ductus arteriosus closure

A patent ductus arteriosus is a fetal remnant that connects the aorta and pulmonary artery. In many cases, these can be closed percutaneously by passing an occluder device from the femoral vessels. Recovery is typically less than 24 hours.

Ablation & Closures

Alcohol Septal Ablation

In patients with thickened hearts that lead to an obstruction of outflow from the heart (hypertrophic obstructive cardiomyopathy), alcohol septal ablation may be able to help. In this procedure, alcohol is injected into targeted vessels to thin the heart muscle in select locations. This leads to a relief of the obstruction and improvement in symptoms.

Perivavular Leak Closure

In rare cases after surgical valve replacement, leaks can form around the surgical valves.  If the leaks are severe, they can cause shortness of breath or low blood counts due to shearing of the blood.  In many instances, these leaks can be closed percutaneously by placing vascular plugs into the areas of leak.

Left Atrial Appendage (LAA) Closure

Left atrial appendage closure is an attractive option for patients with atrial fibrillation who want to reduce their risk of stroke but cannot tolerate long-term anticoagulation.  In this procedure, a closure device is placed via the femoral blood vessels and recovery is usually less than 24 hours.