Open-heart surgery has long been the standard treatment for severe aortic stenosis, a condition in which the heart’s aortic valve narrows and restricts blood flow.
But cardiologists say a less-invasive procedure that was once reserved for the sickest patients is now available to a broader group — including some people considered low risk for traditional surgery.
The procedure, called transcatheter aortic valve replacement, or TAVR, allows doctors to replace a failing aortic valve without opening the chest.
Instead, physicians thread a catheter through a blood vessel — typically from the leg — and guide a replacement valve into position inside the heart.
“It started with possibly open heart surgery, but I wasn’t real keen on that because of all the pain that goes along with it,” said Chuck Young, 70, who underwent the procedure at Henry Ford Health after learning his symptoms were more serious than he initially believed.
Young said he chalked up his fatigue to aging.
“I just assumed I was just getting old,” he said. “That’s what I was feeling.”
A common condition that can be easy to miss
Aortic stenosis develops when the aortic valve becomes stiff or narrowed, forcing the heart to work harder to push blood to the rest of the body.
Symptoms can include shortness of breath, chest pain, dizziness, and a noticeable decline in activity level.
Doctors say some patients minimize those changes, gradually adapting by slowing down.
“He had a very stenotic valve, which means tight, and he was actually more symptomatic than he thought,” said Dr. Nikhil Ambulgekar, a cardiologist at Henry Ford Health. Ambulgekar said that while Young did not initially report classic warning signs such as chest pain or shortness of breath, further discussion revealed he had reduced activities he previously did with ease.
From high-risk option to broader use
TAVR is not new. The Food and Drug Administration first approved the technology in 2011, but it was initially limited to patients considered too high risk to tolerate open-heart surgery.
Over time, clinical trials and longer-term follow-up data have supported expanding eligibility.
Physicians now consider TAVR for additional patients, including some who are at low surgical risk, depending on factors such as anatomy, overall health and life expectancy.
For patients, the appeal is clear: less trauma, shorter hospital stays and faster recoveries.
Young said he was discharged quickly — and felt well enough to return to projects at home sooner than expected.
“I was out the next day,” he said, adding that he “started building a shed” shortly after the procedure.
“It’s very unbelievable how easy it was and how good I felt after it was done,” Young said.
Benefits — and an important tradeoff
In TAVR procedures, the replacement valves used are bioprosthetic valves, which are made in part from treated animal tissue.
Experts say those valves tend to be flexible and do not require long-term blood-thinning medication.
But they do not last as long as fully mechanical valves commonly used in open surgery.
Bioprosthetic valves typically have a usable lifespan of 10 to 15 years, physicians say, though durability can vary depending on a patient’s age, health and other factors.
That reality makes the initial decision between TAVR and open surgery an important one — particularly for younger patients who may outlive the first replacement valve.
If a bioprosthetic valve wears out and a patient remains healthy, doctors may be able to place another valve through a catheter in some cases. Otherwise, the patient may need open-heart surgery to replace the older valve.
A shifting landscape in heart care
Doctors say the evolution of TAVR reflects a broader trend in cardiovascular medicine: using less-invasive approaches when evidence shows outcomes comparable to traditional surgery for selected patients.
Still, cardiologists emphasize that treatment choices should be individualized. Valve anatomy, other medical conditions, lifestyle and long-term planning all play a role, and many hospitals evaluate patients through a “heart team” approach that includes cardiologists and cardiac surgeons.
For Young, the expanded availability of TAVR meant avoiding an operation he hoped to sidestep — and returning quickly to the routines he enjoys.
For doctors, it is one more sign that a procedure once reserved for only the most fragile patients is becoming a mainstream option for many others.