Comparing TAVR and Open-Heart Surgery for Aortic Valve Stenosis

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• Introduction to TAVR and TAVI
• Procedure Comparison: TAVR vs. Open-Heart Surgery
• Advantages of TAVR for Aortic Valve Replacement
• Valve-in-Valve TAVR for Deteriorated Tissue Valves
• Future of Aortic Valve Replacement
• Full Transcript

Introduction to TAVR and TAVI

Transcatheter Aortic Valve Replacement (TAVR), known as Transcatheter Aortic Valve Implantation (TAVI) in Europe, is a minimally invasive procedure for replacing the aortic valve. Dr. Tsuyoshi Kaneko, MD, explains that TAVR is performed through the groin using x-ray guidance, eliminating the need for open-heart surgery and a heart-lung machine. This innovative approach has been commercially available in the United States since 2011.

Procedure Comparison: TAVR vs. Open-Heart Surgery

Dr. Kaneko compares TAVR with traditional open-heart surgery, noting that both procedures have similar operational risks. However, TAVR offers a significantly shorter hospital stay and faster recovery. Unlike open-heart surgery, which requires opening the chest, TAVR is less invasive and typically results in quicker patient discharge and recovery.

Advantages of TAVR for Aortic Valve Replacement

Dr. Tsuyoshi Kaneko, MD, highlights the benefits of TAVR, particularly its minimally invasive nature and rapid recovery time. Patients undergoing TAVR often experience recovery in weeks rather than months, as is common with open-heart surgery. This faster recovery is crucial for improving patient outcomes and quality of life.

Valve-in-Valve TAVR for Deteriorated Tissue Valves

Valve-in-valve TAVR is a procedure used for patients with deteriorated tissue aortic valves, such as those previously replaced with pig or bovine valves. Dr. Kaneko explains that this procedure is performed in a cardiac catheterization laboratory and avoids the technical challenges of re-operation associated with open-heart surgery. It is not applicable to mechanical valves but offers a straightforward solution for tissue valve degeneration.

Future of Aortic Valve Replacement

Dr. Tsuyoshi Kaneko, MD, envisions a future where most degenerated bioprosthetic valves are treated with valve-in-valve TAVR rather than open-heart surgery. This shift is expected to enhance recovery times and patient outcomes, as TAVR allows for faster hospital discharge and improved post-operative recovery. The trend towards minimally invasive procedures like TAVR represents a significant advancement in cardiac care.

Full Transcript

Dr. Anton Titov, MD: Aortic valve stenosis was previously treated only by open-heart surgery. Surgical operation was done to replace the aortic valve. But sometimes replaced heart valves degenerate again. Therefore, repeat surgery is needed. There is an option of transcatheter aortic valve replacement, TAVR. This procedure in Europe is also called Transcatheter Aortic Valve Implantation, TAVI.

Dr. Anton Titov, MD: How would you compare the open-heart surgery to replace the aortic valve with the more minimally invasive interventional procedures like TAVI / TAVR?

Dr. Tsuyoshi Kaneko, MD: Great question! This new technology is called the transcatheter valve. We call it a transcatheter aortic valve replacement, TAVR, in the United States. TAVR is a technique to replace the aortic valve through the groin, typically. It is done under x-ray, without opening your chest.

Dr. Tsuyoshi Kaneko, MD: We are not using any heart-lung machine. Then we are able to exchange the aortic valve without needing any open cardiac surgery. TAVR / TAVI technique has been used since 2011 commercially in the United States. Recently it got approved for a valve-in-valve procedure. This is a procedure used inside of a tissue aortic valve that deteriorated.

Sometimes you had previous aortic valve replacement with a pig valve or a cow [bovine] valve. After 10 years, the pig or bovine aortic valve may not function well. Then there is an option of going through the groin and changing that aortic valve. You can't do it in a previous mechanical valve. You can only do it in a tissue aortic valve.

Dr. Tsuyoshi Kaneko, MD: We have looked at our repeat aortic valve replacement series a couple of years ago. We compared open surgery versus valve-in-valve transcatheter aortic valve replacement. It showed that the risk of operation was about the same. But the length of stay in the hospital and the recovery was much faster with TAVR / TAVI.

Dr. Anton Titov, MD: Since then, there have been several reports in the TAVR world using the newest generation aortic heart valves. It was shown that the results are actually better, superior, in TAVR compared to open aortic valve replacement surgery.

In my eyes, re-operation to exchange the aortic valve that was already implanted is actually a technically difficult operation. You have to go through the scars. You have to take out the old heart valve prosthesis. You have to place a new aortic heart valve in.

Dr. Tsuyoshi Kaneko, MD: You need to place the valve in an aorta that’s damaged already. It is technically more challenging than a standard aortic valve replacement operation. Considering that, this aortic valve-in-valve is actually a relatively straightforward procedure. We do it in the cardiac catheterization laboratory.

Of course, the recovery after valve-in-valve replacement is much faster. I foresee in the future that most of the degenerated bio-prostheses will be treated with valve-in-valve TAVR. Replacement of previously implanted tissue aortic valves will not be done via open heart surgery. I think that time is coming.

This obviously makes the recovery faster. Potentially, patients move faster out of the hospital. Patients after TAVI feel better faster.

Dr. Tsuyoshi Kaneko, MD: Correct, absolutely! Interestingly, after valve-in-valve TAVR, patients will recover in weeks rather than in months. It takes months to recover after open heart surgery to replace the aortic valve. From the recovery standpoint, there is no question that this minimally invasive procedure provides much faster recovery. It's very important.