Aortic stenosis is a condition where the heart valve that sends blood throughout the body becomes narrowed. When the heart's exit is blocked in this way, symptoms such as shortness of breath and chest pain appear.

Heart valve disease is a common condition found in 3 out of 10 people aged 75 and older. According to Statistics Korea, heart disease has been the second leading cause of death in the country after cancer for the past decade. However, compared to cancer, it is less recognized and often goes untreated until symptoms become severe, leading to missed treatment opportunities.

An interview with Professor Lee Joong-hee of the Department of Cardiology at Wonju Severance Christian Hospital provided detailed insights into the diagnosis and latest treatments for aortic stenosis, as well as the role of regional hub hospitals in treating severe cardiovascular diseases.

―What is aortic stenosis?

“Aortic stenosis is a condition where the heart valve degenerates and calcifies with age, preventing smooth blood flow. The most common cause is degenerative changes due to aging. It can also result from rheumatic valve disease or the aftereffects of past inflammatory diseases. Symptoms include shortness of breath, chest pain, and fainting. It is reported that about 50% of patients die within two years if not treated after symptoms appear, making it a fatal disease. There is also a risk of sudden death, so early treatment is crucial. In emergency medicine, 'emergency' refers to a condition where life is at risk within 1-2 days if treatment is delayed. Most aortic stenosis patients do not require immediate emergency treatment, but if sudden heart failure or shock occurs even in asymptomatic patients, emergency procedures may be necessary. Conversely, if symptoms are present but the overall condition is stable, treatment is planned according to a set schedule.”

―How is it diagnosed?

“Most diagnoses occur during examinations after the three main symptoms of shortness of breath, chest pain, and fainting appear. It is also often diagnosed incidentally during health check-ups or examinations for other diseases. Echocardiography is the primary diagnostic method used. It is the most basic and effective test to check both the anatomical structure and functional abnormalities of the valve. Accurate diagnosis is possible with interpretation by skilled medical professionals. Generally, it is diagnosed as severe if the valve area is less than 1.0㎠, the mean pressure gradient is over 40mmHg, or the maximum blood flow velocity is over 4.0m/s.”

―Does the treatment method vary according to severity?

“For asymptomatic severe patients, regular echocardiographic follow-up is recommended every 3-6 months, and for moderate or less severe patients, every 6 months to 1 year. If symptoms are present, valve replacement surgery is necessary. Treatment is chosen by comprehensively considering the patient's age, overall condition, and surgical risk, selecting between surgical operation or transcatheter aortic valve implantation (TAVI).”

―What is TAVI?

“TAVI is a method where a catheter device is inserted through the femoral artery without opening the chest to position a new artificial valve inside the narrowed valve. When the valve reaches the heart, it gradually expands at the precise location, pushing the existing valve aside and taking its place. The new valve is fixed with a stent structure, maintaining normal blood flow. This process is precisely conducted under X-ray guidance. Compared to traditional surgery, it has the advantages of less physical burden and faster recovery, making it particularly suitable for elderly or high-risk patients.”

―Does the artificial valve need replacement over time?

“The valve used in TAVI is made of biological tissue. Over time, function may deteriorate due to calcification or thrombus formation. While it is possible to surgically remove the existing valve and insert a new one, the surgical burden is significant due to the high number of elderly patients. Therefore, in actual clinical practice, a 'valve-in-valve procedure' is used, where a new valve is inserted inside the existing one.”

―What is the effectiveness of TAVI?

“In Korea, nationwide long-term follow-up data of over 10 years is not yet available. However, individual institutions have mid- to long-term clinical results. Overseas, numerous clinical studies with over 10 years of follow-up have been published. A representative study is the 'NOTION trial,' which tracked low-risk patients who underwent surgical treatment and TAVI with a self-expanding valve for 10 years. The comparison showed no significant difference in overall mortality and rehospitalization rates due to heart failure. Hemodynamic indicators (such as pressure gradients measured by echocardiography) showed that TAVI had better results than surgery. Recently, 5-year data evaluating the effectiveness and safety of self-expanding valves in low-risk patients was released, showing that TAVI had an advantage over surgery in pressure gradient indicators.”

―Are there any complications after the procedure?

“The main complications are bleeding at the procedure site and conduction disturbances (atrioventricular block). Bleeding can occur during the femoral artery insertion process, and the incidence rate is decreasing with the operator's proficiency. It is generally reported to be less than 1%. Conduction disturbances occur when the artificial valve stimulates the heart's electrical signal transmission area, and some patients (5-10%) may require pacemaker insertion. Rare but fatal complications include aortic rupture, which can be sufficiently prevented through pre-procedure CT evaluation.”

―Can TAVI be performed at all hospitals?

“TAVI is classified as a high-difficulty interventional procedure. Multidisciplinary collaboration is essential, involving cardiology, thoracic surgery, anesthesiology, and radiology. It requires a certain number of procedure experiences and infrastructure, so currently, it is mostly performed at tertiary medical institutions in Korea. However, there are exceptional cases where it is performed at some secondary hospitals with specialized cardiac capabilities.”

―What are the characteristics or treatment accessibility for patients in the Gangwon region?

“Gangwon-do has a high proportion of elderly population and a wide area, making hospital accessibility relatively low. As a result, there are cases where treatment is delayed despite symptoms, and patients visit when the disease has progressed significantly. Wonju Severance Christian Hospital has established various collaborative systems and referral networks to ensure regional patients receive treatment more quickly. Many patients receive high-quality procedures without long-distance travel. Our hospital is the only tertiary medical institution in the region equipped with independent TAVI procedure conditions and capabilities. We closely cooperate with primary and secondary medical institutions to improve treatment accessibility for patients in the Gangwon region. We are a key part of a public medical network with agreements with a total of 75 medical institutions. Through referrals, joint consultations, technical advice, and education, we strengthen the medical delivery system in the Gangwon region and contribute to enhancing the stability of the regional healthcare system.”

―Finally, any message for patients with aortic stenosis or their guardians?

“Aortic stenosis has a good prognosis if diagnosed early and treated appropriately. Recently, treatment methods have diversified, and effective treatment is possible not only for high-risk groups but also for relatively healthy elderly patients. If symptoms are suspected, it is recommended not to delay and consult a specialist. It is crucial to visit the hospital early if symptoms are present. Even without traveling long distances to the metropolitan area, high-difficulty treatment is sufficiently possible at our hospital, so I would advise visiting promptly to receive appropriate treatment.”

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