Aortic valve stenosis is a condition where the aortic valve—the gateway through which blood flows from the left ventricle to the rest of the body—becomes narrowed. The heart contains four valves that ensure blood flows in one direction without backflow during the heart's pumping action. Through the process of opening and closing more than 100,000 times daily, valves can become hardened, thickened, and stenotic due to aging. The aortic valve is particularly prone to stenosis, with prevalence rates exceeding 10% reported among those 75 and older.
"Aortic valve stenosis carries a risk of sudden death once symptoms such as shortness of breath or chest pain appear, requiring surgery to replace the valve with an artificial one," said Professor Lim Young-hyo, a specialist in aortic valve procedures at Hanyang University Hospital's cardiology department. "With the spread of TAVI (Transcatheter Aortic Valve Implantation) procedures in recent years—which involve making a small incision in the thigh and inserting a catheter to replace the artificial valve—elderly patients can now receive active treatment."
Professor Lim will appear on Seoul Economic TV's "Now, Master Physician" airing at 9 PM on the 21st to explain the symptoms, diagnosis, and treatment criteria for aortic valve stenosis, a leading cardiac disease threatening the elderly population.
Three Major Symptoms: Shortness of Breath, Dizziness, Chest Pain
Age is a critical factor in aortic valve stenosis, as it involves degenerative changes in the heart valve. "With rapid population aging, aortic valve stenosis patients are increasing," Professor Lim explained. "The likelihood increases when atherosclerosis progression due to aging combines with risk factors such as hypertension, diabetes, and hyperlipidemia." In rare cases, patients born with bicuspid rather than tricuspid valves may develop stenosis at younger ages.
The aortic valve opens when blood flows from the left ventricle to the aorta and closes during cardiac relaxation to prevent backflow. When this valve narrows, blood cannot be adequately delivered throughout the body, causing various symptoms. "Initially, patients experience declining energy levels, which is easily mistaken for normal aging," Professor Lim noted. "If an elderly person who was doing well suddenly experiences rapid energy decline and reduced activity, aortic valve stenosis should be suspected."
The three major symptoms are shortness of breath, dizziness or fainting, and chest pain. "If symptoms appear but remain untreated, prognosis can deteriorate rapidly," Professor Lim emphasized. "It is known that mortality risk increases within 5 years for fainting, 3 years for chest pain, and 2 years for heart failure symptoms."
Diagnosis Via Echocardiography; Active Treatment Considered for Severe Stenosis With Symptoms
Aortic valve stenosis is diagnosed through echocardiography. "Whether aortic valve stenosis is present can be confirmed relatively easily with ultrasound alone," Professor Lim said. "Since this examination requires no medication and is painless, I recommend getting a cardiac ultrasound at a nearby clinic if suspicious symptoms appear." After diagnosis, patients are often referred to tertiary hospitals for detailed evaluation to determine if treatment is necessary.
Treatment timing depends on the degree of stenosis and presence of symptoms. Mild to moderate cases are mostly monitored, but when severe stenosis is accompanied by fainting, chest pain, or shortness of breath, procedures or surgery should be actively considered.
The traditional treatment for aortic valve stenosis is Surgical Aortic Valve Replacement (SAVR). This involves cutting through the sternum, directly exposing the heart, completely removing the narrowed valve, and replacing it with an artificial valve. Surgery typically takes 6 to 10 hours. Because the heart must be stopped and a heart-lung machine used, hospitalization lasts approximately 1 to 2 weeks, with recovery taking several weeks or more. "Surgery has been established as the standard treatment for a long time," Professor Lim explained. "For relatively younger patients or when long-term valve durability is important, surgery can still be a good choice."
TAVI Gains Attention as Alternative to Surgery
TAVI involves sending an artificial valve through leg blood vessels via catheter up to the heart, then expanding and securing the new valve inside the existing valve rather than removing it. Compared to surgery, the incision burden is minimal, and procedure time is shorter at around one hour. Recovery is fast, with most patients able to be discharged within 2 to 3 days. It is particularly gaining attention as a new treatment option for elderly patients or those with high surgical risk. "The artificial valve must be compressed small, inserted through blood vessels, and expanded at the precise location in the aorta," Professor Lim said. "Since aortic size varies by individual, we precisely measure blood vessel and valve dimensions using computed tomography (CT) to select a customized size."
Given that TAVI is a delicate procedure, preparing for complications is important. "Patients whose coronary artery openings are anatomically low face risk of the valve blocking coronary arteries, requiring advanced strategies," Professor Lim noted. "Hanyang University Hospital operates a multidisciplinary TAVI team where cardiology, thoracic surgery, anesthesiology, and radiology share patient information and determine treatment strategies through conferences when needed."
TAVI Covered by Health Insurance for High-Risk Surgical Patients 80 and Older
TAVI is not the answer for all aortic valve stenosis patients. Treatment methods are selected by comprehensively considering age, surgical risk, and valve lifespan. "Tissue valve lifespan is generally 10 to 15 years, which is sufficient for patients in their 80s, but for those in their 60s, surgical treatment may be better considering the possibility of future re-intervention," Professor Lim explained. He also noted that mechanical valves have longer lifespans but require lifelong anticoagulant (warfarin) use as a comparison factor.
While TAVI procedure costs run into tens of millions of won, treatment accessibility has improved with health insurance coverage for those 80 and older. High-risk surgical patients 80 and older who undergo TAVI pay only 5% out-of-pocket.
Recovery is faster compared to surgery. "After the procedure, patients are monitored in the ICU and then moved to a regular room, where we have them walk immediately," Professor Lim emphasized. "If elderly patients remain bedridden for too long, muscle strength drops rapidly, which actually hinders recovery." Discharge within 2 to 3 days is possible if the condition is stable. "Symptoms like shortness of breath or chest discomfort should not be dismissed as simply due to age," Professor Lim urged. "Diagnosis through cardiac ultrasound alone can significantly reduce the risk of future death."
Professor Lim recently observed a 95-year-old patient who underwent TAVI after much deliberation return for an outpatient visit with a transformed facial expression and high satisfaction with the procedure. "Age is just a number—treatment that restores a comfortable life is possible," he emphasized.