TAVI or open heart surgery for aortic valve stenosis? How to compare treatment options? 2
Aortic valve stenosis was previously treated only by open-heart surgery. Dr. Anton Titov, MD. Surgical operation was done to replace the aortic valve. But sometimes replaced heart valves degenerate again. Therefore, the repeat surgery is needed. There is an option of transcatheter aortic valve replacement, TAVR. Dr. Anton Titov, MD. 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 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 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. Dr. Tsuyoshi Kaneko, MD. 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. 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 much faster with TAVR / TAVI [transcatheter aortic valve implantation]. Dr. Anton Titov, MD. Since then there has 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. It 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 actually is a relatively straightforward procedure. Dr. Tsuyoshi Kaneko, MD. We do it in the cardiac catheterization laboratory. Of course, the recovery after valve-in-valve replacement is much 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. Dr. Anton Titov, MD. Potentially patients move faster out of the hospital. Patients after TAVI feel better faster. Correct, absolutely! Interestingly, after valve-in-valve TAVR patients will recover in weeks rather than in months. Dr. Tsuyoshi Kaneko, MD. It takes months to recover after open heart surgery to replace aortic valve. From the recovery standpoint, there is no question that this minimally invasive procedure provides much much faster recovery. It’s very important.
How can patients avoid mistakes when dealing with a medical problem? Leading doctors share wisdom: