Aortic Stenosis is a condition where the aortic valve of the heart does not open completely because of the thickened valve leaflets, causing irregular heart functioning and creating pressure on the left ventricle of the heart – which is mainly responsible for pumping blood. In such a condition, the heart responds by thickening the walls to retain the pumping pressure. However, it might weaken the heart and even lead to heart failure, if not treated in time. Two major treatments for Aortic Stenosis are Transcatheter Aortic Valve Replacement (TAVR) and Surgical Aortic Valve Replacement (SAVR).
A Transcatheter Aortic Valve Replacement (TAVR) or Transcatheter Aortic Valve Implantation (TAVI) is a surgical method performed to repair a compromised, blocked or narrowed artery which was disrupting the blood and oxygen supply to the heart. This surgical procedure is recommended for patients who have a higher risk or are too sick or suffer from severe aortic stenosis, or too old for open-heart surgery. This breakthrough procedure is advanced than a standard valve replacement.
Where no other procedure guarantees long term benefits, this procedure provides a statistically significant mortality rate and is regarded as a boon for people who were considered inoperable. It was, in fact, first tested in 2002 on patients with severe aortic stenosis (a narrowing of the aortic valve opening), who were considered unfit for open-heart surgery. TAVI/TAVR outperformed in the trials with patients’ significantly better recording higher mortality rate.
Not only does a TAVI/TAVR procedure act as shining armour for a heart patient with no hope, it also has faster recovery time in general cases. The ease of performing, recovery time and the process is as simple and equivalent to that of a coronary angioplasty or in some cases even coronary angiography. In most cases, a patient is expected to recover within 3-4 days post a TAVI/TAVR procedure. During the recovery, the doctors will prescribe medicines and also follow up with tests and physical examinations.
That said, a TAVI/TAVR treatment has both benefits and risks involved. Some of the benefits include:
- Reliable alternative to open-heart surgery
- High survival rate
- Less invasive
- Less damage or chances of infection
- Faster recovery period
Risks involved in a TAVI/TAVR procedure include:
- Abnormal heartbeat and rhythm
- Kidney disease
- Adjustment problems with replaced valve
On the other hand, Surgical Aortic Valve Replacement (SAVR) was the standard treatment for patients suffering from severe aortic stenosis, until the discovery of TAVR/TAVI. Surgical Aortic Valve Replacement istraditional,open chest surgery that replacesdamaged aortic valves and is recommended for patients whose condition is strong enough to manage this surgery and the recovery. A SAVR is preferred for patients with low-risk. In SAVR procedure, an incision is made in the chest to reach the heart; once through, the heart is placed on a heart-lung bypass machine, while the damaged aortic valve is replaced with a new one. The heart is then restored and the incision is closed. SAVR has shown great results on patients who are suitable for the surgery. Though the recovery time post a SAVR procedure is long and approximately requires 5-7 days of hospitalization, plus at least 6 weeks of full recovery.
Benefits of choosing to a Surgical Aortic Valve Replacement are:
- Lower chances of a permanent pacemaker
- Matured method
- Long span of valve
A SAVR procedure may involve certain risks such as:
- Blood clots
- Irregular heart rate
- Longer recovery time
- Acute kidney injury
- Blood transfusion
On one-to-one comparison, A TAVR scores much higher than a SAVR on various parameters such as non-invasiveness, shorter recovery period, lower risk of complications, uncertain life span of the valve, better quality of life, and estimated longer span of life. However, for cases where the patient needs a valve replacement, an open-heart surgery – SAVR is the ideal choice.
That said, there are multiple other factors (listed below) that play a significant role in evaluating the choice between TAVR and SAVR.
- Anatomical parameters such as the size of the aortic valve and blood vessels, size of the aortic annulus, etc.
- Type and severity of aortic disease such as coronary artery, multi-valve, bicuspid valve, etc.
- Other health issues such as diabetes, lung problem, heart attack history. etc.
- Frailty such as age, power grip, physical activeness, etc.
It is very important to weigh all benefits and risks while evaluating all options of treatment. Even the doctor will consider all factors and also conduct several tests such as an ultrasound, echocardiogram, cardiac CT scan, and cardiac catheterization to determine which procedure from TAVI/TAVR or SAVR is best suited to your condition.