Aortic stenosis is the most common valvular disease in developed countries. Its origin usually lies in the degeneration or calcification of the valve, caused by the passage of years. Over time there is a progressive calcification of the aortic valve that causes a restriction in its mobility and its opening.
The most common symptoms of aortic stenosis are angina (chest pain), difficulty breathing (dyspnea), and syncope (loss of consciousness). Although it may not produce symptoms for many years, when they appear the disease progresses rapidly and the prognosis is bad. The average survival if no treatment is received when symptoms appear is 2 to 5 years.
When the stenosis is severe and produces symptoms, the treatment to be performed is aortic valve replacement surgery. This procedure, described in another section (see the section: Valve Prosthesis – Replacement Valvular ), it is performed open – heart surgery with extracorporeal circulation. However, there are patients in whom surgical risk is prohibitive (very high mortality) or they may have contraindications for aortic valve replacement surgery.
For these patients have developed transcatheter techniques, in which a prosthesis can be implanted in the aortic position percutaneously, ie without stopping the heart and opening the chest. This can be done through the femoral artery (via transfemoral) or through a small incision between the ribs and without extracorporeal circulation (transapical).
The implantation of a prosthesis by transfemoral route is carried out by Interventional Cardiologists in the Laboratory of Hemodynamics. In transapical surgery, the implant is performed in the operating room of Cardiac Surgery. In the latter case, an opening of the sternum is not performed, but rather, through a small incision below the left breast, passing between the ribs, it reaches the tip of the heart. With the heart beating, a small incision is made in the tip of the same and a device is introduced that carries the folded prosthesis. By means of radiological and echocardiographic control, the device is placed at the level of the aortic valve and expands, and the prosthesis is implanted in the aortic position. All this without extracorporeal circulation. The opening of the tip of the heart and the incision of the skin are then sutured.
Like any patient, the patient is transferred to the ICU (Intensive Care Unit), and follow the same steps as any patient undergoing heart surgery (see the section: After Cardiac Surgery ). Usually, the postoperative stay is lower than in the rest of the patients.
It is important to note that these techniques today are only suitable for patients in whom standard aortic valve replacement heart surgery can not be performed because of a very high risk of complications.