Aortic Stenosis Treatment
Understanding Aortic Stenosis Treatment In Older People
If you or a loved one has been diagnosed with aortic stenosis, you may have questions about the treatment journey ahead, and what this means for your future care. Here, we are exploring what aortic stenosis is, what the main treatments entail for older adults, the role of home care in treatment, what older people and their families need to know about living with this condition, and how home care can help with cardiac care.
At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For over 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about aortic stenosis in older adults, we can help.
What is aortic stenosis in older adults?
If you have ever heard of the term ‘congenital heart disease’, this refers to a number of potential heart defects, one of which is aortic stenosis, or aortic valve stenosis. This is a serious defect that causes a narrowing of the aortic valve, which is the valve that controls blood flow from the heart’s left ventricle (the main pumping chamber) to the aorta (the main artery in the body). When this happens, it also affects the flow of blood to the heart, redirecting it to other areas of the body. This puts additional strain on the muscles of the left ventricle, causing them to thicken.
As with any heart defect, this can cause symptoms such as:
- Blue skin or lips
- Rapid breathing
- A rapid heartbeat
- Swelling in the legs, abdomen, hands, ankles, feet or around the eyes
- Shortness of breath or fainting during exercise
- Severe fatigue
Aortic stenosis can be congenital (meaning it has been present from birth) and affect all ages, or it can be acquired as the person gets older. It is most commonly found in older adults over the age of 60, and in many cases although it begins after 60, symptoms don’t begin to show until the person is in their 70s or 80s.
The prevalence of aortic stenosis is low in those under 60, and increases to around 10% in patients over the age of 80. An estimated 1 in 8 people over 75 have moderate to severe aortic stenosis, and the severity tends to increase with age. For clarity, most of these patients will experience only mild thickening, known as aortic sclerosis, which will maintain normal valve function. In around 2-5% of these cases, more significant aortic stenosis will occur.
Comorbidities are common with aortic stenosis, and may include heart issues such as coronary disease and atrial fibrillation. Other comorbidities may include common conditions like hypertension, diabetes, chronic kidney disease, dementia or cancer.
Over time, untreated aortic stenosis can cause calcification which leads to heart failure or a sudden cardiac event resulting in death. In the asymptomatic phase, many people can continue to live as normal, however mortality rates rise to over 90% in just a few years once symptoms begin, so early diagnosis and treatment could be vital.
Progressive stages of aortic stenosis affect symptoms, as the heart works increasingly harder to pump blood due to thickening. The four stages are:
- Initial risk of developing aortic stenosis
- An obstruction of blood flow in the aortic valve
- A severe obstruction without symptoms
- A severe obstruction with symptoms present
What are the main treatment pathways for aortic stenosis?
There are several treatment pathways for older people with aortic stenosis, but the main 3 are surgical, non-surgical, and management.
Surgical Valve Replacement
The best treatment for aortic stenosis is thought to be surgery to replace the valve that is causing problems. There are different types of surgery available depending on the situation and type of aortic stenosis, so the surgeon will create a bespoke surgical plan for each case. In more severe heart defects where the valve is particularly narrow, an urgent valve replacement procedure may be required.
A valve replacement is a type of open-heart surgery, meaning a surgeon will be operating directly on the person’s heart to replace the valve with either a mechanical valve or a biological valve made of tissue from a cow, pig or human organ donor. The surgeon will determine the best type of valve to use.
Another type of valve replacement is called the Ross Procedure, which involves replacing the aortic valve with the person’s own pulmonary valve, which is then replaced by donor tissue. However, current guidelines recommend this procedure primarily for patients under 50, as its long-term benefits are most relevant to younger adults with a longer life expectancy ahead of them. It is therefore rarely considered for older adults, for whom surgical valve replacement or TAVI will usually be the more appropriate option.
Keep in mind that after surgery, you may be required to take medication for the rest of your life to prevent blood from clotting around the new valve. This type of treatment is known to have a high success rate, so for those fit enough to manage the surgery and anaesthesia, a valve replacement will usually be recommended as a new valve could remain effective for decades. A 2021 study found that the median survival was 10.9 years in low-risk patients, 7.3 years in intermediate-risk patients, and 5.8 years in high-risk patients.
Recovery from valve surgery may take 6-8 weeks, with around a one week stay in hospital provided there are no complications. You may begin in an Intensive Care Unit and later be moved to a ward for recovery. The surgical site will usually heal in 6-8 weeks, but it could take up to 3 months to feel back to normal, fully mobile, and able to exercise.
Transcatheter Aortic Valve Implantation (TAVI)
For some patients–particularly those for which surgical valve replacement may be too risky–a Transcatheter Aortic Valve Implantation, or TAVI, may be a more appropriate form of treatment. This minimally invasive procedure also inserts a new valve, however this is done via a catheter and through an artery in the groin. The original valve is not replaced, so the new valve will be positioned within this existing, damaged valve to regulate blood flow.
Recovery after the TAVI procedure is often faster than in a surgical valve replacement, and in some cases patients may be home from hospital in just a couple of days. Patients will be advised not to do strenuous activity such as heavy lifting for up to 6 weeks, depending on where in the body their TAVI took place, and medication may be needed following the procedure. Recovery times differ, but it usually takes 6-10 weeks to feel fully back to normal.
For older adults who may not be able to handle open-heart surgery or the associated anaesthesia, a TAVI procedure could have a significant positive impact on their quality of life and increase their survival rates; studies find that survival rates in those aged 80+ who have had a TAVI procedure are similar to the general population, so this procedure is carried out more than surgical valve replacement in the UK.
Medical Management
In some cases, surgical intervention or a TAVI procedure may not be appropriate for the individual, and although the condition will inevitably progress, some symptom control strategies could be implemented to manage this temporarily. These strategies may also be implemented for those with no symptoms, mild symptoms, or those on a waiting list to have a procedure.
Medications cannot solve the problem of the narrowed aortic valve, but they can help to manage associated issues like high blood pressure, fluid retention, or an irregular heartbeat. Some of the most common medications or strategies for this include:
- Diuretics to reduce fluid buildup
- ACE inhibitors to manage blood pressure and improve heart efficiency
- Anti-arrhythmic medications to regulate heart rhythm
- Dietary changes such as limiting salt intake
- Maintaining a healthy weight
- Avoiding strenuous activity
Patients with aortic stenosis will usually require regular heart monitoring via an echocardiogram to track the progression of the condition. Keep in mind that while aortic stenosis can be managed with medication and lifestyle changes, this will only help to temporarily ease symptoms – a long-term treatment plan will usually be needed to solve the underlying issue, depending on the patient’s suitability for surgery or a procedure like TAVI.
What role does home care play in treating aortic stenosis?
Management of and recovery from aortic stenosis can be challenging for older adults, particularly if they suffer from additional health conditions. Having access to home care can help in a number of ways, including:
- Helping to create a symptom diary for initial diagnosis
- Providing postoperative recovery care for after valve replacement surgery
- Medication management, either after a TAVI procedure or surgical valve replacement, or to manage the condition temporarily without such procedures
- Ensuring adherence to lifestyle changes or dietary changes, as recommended by their doctor
- Providing vital signs monitoring to check for worsening symptoms or emergencies
- Assisting in preparing for a stint in hospital, such as arranging transport or gathering necessary documents
- Offering emotional support before, during and after treatment
- Providing wound care after surgery or a TAVI procedure
- Helping to ensure follow-up appointments are attended
- Supporting mobility rehabilitation with gentle exercises, as advised by their doctor
- Monitoring for complications such as infections or fluid retention, and reporting concerns to the relevant medical professionals
Remember, recovery from valve surgery may take up to 8 weeks, and TAVI procedure recovery could be up to 10 weeks, so having help at home following either of these procedures could take stress away from an older person during recovery.
Professional caregivers can also provide support in the form of palliative care for those unable to undergo surgery, to aid with symptom relief (such as managing breathlessness or pain), help with advanced care planning, provide emotional assurance, and to ensure quality of life as they continue to live with this condition.
What are some other considerations when managing aortic stenosis?
When managing aortic stenosis, older adults and their caregivers should be aware of several factors that can impact people living with this condition:
- Undergoing a frailty assessment, such as the Rockwood Frailty Scale, can help to determine whether an older person has the resilience necessary to tolerate a surgical treatment or procedure like a TAVI. This places people on a sliding scale from ‘Very Fit’ to ‘Very Severely Frail’, or in some cases ‘Terminally Ill’. A higher frailty score could indicate that these treatments are not suitable, and could lead doctors to instead recommend symptom management or palliative care.
- Cognitive health must be considered when managing aortic stenosis, since this condition can reduce blood flow to the brain in some cases, causing issues with executive functioning, attention, and memory. Carers must be aware of these potential issues and monitor the person’s mental state in case support is needed.
- Older adults tend to require more medications than other age groups, so managing these in case of interactions or side effects is important. For example, taking diuretics can cause dizziness, so older people may need extra help to avoid illness or injury.
- Nutritional needs are important when living with aortic stenosis, and after treatments, so caregivers should encourage older people to eat a balanced diet to support their heart health, energy and recovery after surgery or a TAVI procedure. Post-surgery, a high protein diet is often recommended since loss of muscle mass happens more quickly for older adults on bed rest – a 2024 study found that while most people experience a 2-5% daily decline in muscle mass if not walking, older people may lose up to 10% of their muscle mass in just 7 days of immobility.
- Having regular follow-up appointments with GPs and cardiologists is essential when living with aortic stenosis, or after a surgical procedure, to monitor heart function. These appointments can help to check everything is as it should be, adjust medications if necessary, and plan ahead for further care needs. Research suggests those with moderate aortic stenosis should have echocardiography every 1-2 years, while those with severe aortic stenosis should receive this every 6-12 months. Caregivers can help to coordinate these appointments, report symptoms to the person’s GP, and ensure older adults adhere to their recommended treatment plan.
How can home care help provide cardiac care support?
Home care can be an essential part of living with aortic stenosis, or in recovering from treatments. At Home Instead, we can support older adults by matching them with a caregiver specially trained in supporting recovery, and who understands the unique health and mental health needs of an older adult living with a heart condition.
Our caregivers understand what to look out for in terms of side effects, progressive symptoms and complications following treatments. We can collaborate with each patient’s cardiac rehabilitation team and GP in order to provide the very best, holistic care that assists their recovery and provides the emotional support needed.
Whether you need occasional visiting care for a loved one following their treatment, constant live-in care to manage the progressive symptoms of aortic stenosis, or ad-hoc respite care to take over while regular caregivers take a break, we can help. Our experienced, supportive Care Professionals can provide everything you need to manage life at home with aortic stenosis, whether this is an ongoing situation or you are seeking treatment in the form of surgery or a TAVI procedure.
We’re an award-winning home care provider and part of a worldwide organisation devoted to providing the highest-quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.
