Aortic Valve Disease | UNC Heart Valve Clinic

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, or patients attribute their symptoms to the aging process.

Transcatheter Aortic Valve Replacement (TAVR)

Transcatheter aortic valve replacement (TAVR) is an alternate treatment option to conventional open heart surgery, and TAVR has shown to have equal, and sometimes better outcomes than traditional surgery. TAVR is now an option for patients in all risk categories including inoperable, high, intermediate, and low surgical risk. Some patients prefer a minimalist approach to valve replacement, compared to more invasive surgery. Severe symptomatic aortic stenosis is a life threatening condition. 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.

Our heart team within the TAVR program 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 Heart Valve Clinic by interventional cardiologists, cardiothoracic surgeons, a structural heart disease fellow, nurse practitioners, physician assistants and nurse coordinators 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 Cardiothoracic 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.

Visit the Division of Cardiothoracic Surgery in the Department of Surgery.

Aortic Valve Regurgitation

Aortic regurgitation occurs when the aortic valve does not close completely, allowing blood to leak backward into the heart after each heartbeat. As a result, the left ventricle must work harder to pump enough blood to the body. Over time, this extra strain can lead to heart enlargement, reduced heart function, shortness of breath, fatigue, and heart failure.

Transcatheter Aortic Valve Replacement (TAVR) for Aortic Regurgitation with the JenaValve Trilogy System

JenaValve is a minimally invasive transcatheter heart valve therapy designed specifically to treat severe aortic regurgitation (AR), also known as aortic insufficiency. For patients who are at high risk for open-heart surgery, JenaValve may offer an alternative treatment option that can improve symptoms and quality of life.

For many years, surgical aortic valve replacement was the primary treatment option for severe aortic regurgitation. However, some patients face increased risks from open-heart surgery due to age, medical conditions, or overall health status. The JenaValve Trilogy system now offers a minimally invasive alternative for eligible patients who are considered high-risk surgical candidates.

Most transcatheter heart valves were originally designed to treat aortic stenosis and rely on calcium deposits in the valve for stability. Patients with aortic regurgitation often do not have enough calcium for those devices to anchor securely. The Trilogy valve was specifically engineered to overcome this challenge through proprietary locator technology that attaches to the native valve leaflets, providing stable positioning and secure anchoring.

Patients being considered for JenaValve therapy benefit from evaluation by a dedicated Heart Team that may include:

Interventional cardiologists
Cardiothoracic surgeons
Cardiac imaging specialists
Nurse coordinators and advanced practice providers

Working together, the team reviews your condition, diagnostic imaging, symptoms, and overall health to determine the most appropriate treatment plan for your individual needs.

Procedure:

JenaValve therapy is performed through a minimally invasive transcatheter approach. Instead of opening the chest and replacing the valve through traditional surgery, your physician delivers a collapsible replacement valve to the heart through a catheter.

The valve is carefully positioned within your native aortic valve and then expanded into place. The system’s unique locator technology helps align and secure the valve to the native valve leaflets, providing stability and reducing leakage.

The most common approach uses the femoral artery in the groin:

A catheter is inserted through an artery in the groin.
The replacement valve is advanced to the heart.
The valve is positioned within the diseased aortic valve.
The new valve is deployed and begins functioning immediately.

Most patients can expect a shorter recovery period compared with open-heart surgery, although hospital stay and recovery time vary based on individual health conditions.

Outcomes:

Clinical studies have demonstrated promising results for patients with severe, symptomatic aortic regurgitation treated with JenaValve technology. Benefits may include:

Significant reduction or elimination of aortic regurgitation
Improved symptoms and functional status
Improved heart function and remodeling
Minimally invasive treatment without open-heart surgery
Shorter recovery compared with traditional surgical valve replacement for many patients

For patients with severe aortic regurgitation who are at increased surgical risk, JenaValve represents an important advancement in transcatheter heart valve therapy and expands treatment options for a condition that historically had limited nonsurgical alternatives.

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