TAVR (TAVI) or open surgery? What are risks of TAVI? Multidisciplinary Team must evaluate all patients with aortic stenosis. 4
How to choose between open heart surgery to replace aortic valve and new minimally invasive transcatheter aortic valve replacement TAVR (TAVI, implantation)? Aortic valve replacement by TAVR? Or open heart aortic valve replacement surgery? Dr. Anton Titov, MD. A patient comes to a surgeon and the surgeon says. “You could be suitable for the classic aortic valve replacement by open-heart surgery. Dr. Marc Pelletier, MD. But we also could do this new procedure, TAVR. We could do both methods to replace your aortic heart valve.” Dr. Anton Titov, MD. How would as patient weigh the risks of TAVR vs. open heart surgery? How well the aortic valve will function after TAVR? Dr. Marc Pelletier, MD. Recovery after the TAVI / TAVR is much faster. Transcatheter aortic valve replacement is minimally invasive. Dr. Anton Titov, MD. What are other considerations that patient with aortic stenosis should think about? It’s really important for aortic stenosis patients to get a good idea of what their treatment options are. The best method to do that is to be assessed by a surgeon. Surgeon has to be a part of a comprehensive heart treatment team. Dr. Marc Pelletier, MD. There are surgeons who are doing Transcatheter aortic valve replacement. They are really linked into a comprehensive heart therapy team. This involves a non-interventional cardiologist, an interventional cardiologist, a surgeon, a TAVR coordinator. We run such clinics here at at our hospital. There are many other centers that do it as well. That is really the best method. A multidisciplinary team that makes a fair assessment of the best heart disease treatment procedure for a patient. Multidisciplinary team assessment. Dr. Marc Pelletier, MD. Yes. The problem sometimes is this. A patient with aortic stenosis sees a surgeon who has never done a TAVI. Some cardiac surgeons have no involvement with TAVI. That surgeon will inherently have a bias of what treatment that patient should have. In a similar fashion, an opposite situation may happen. Dr. Marc Pelletier, MD. Patient with Aortic stenosis may see a surgeon or a cardiologist who only does TAVI / TAVR. They never do open heart surgery. They would have also the same type of bias towards TAVR / TAVI procedure. The two aortic valve replacement procedures are very equal on many levels. But there are some patients that do much better with one type of aortic valve replacement procedure. Other patients with aortic stenosis do better with another type of aortic valve replacement procedure. Dr. Anton Titov, MD. It is best to get a fair and balanced opinion from somebody who’s part of a comprehensive heart team. Dr. Marc Pelletier, MD. This is to me is absolutely crucial. It is crucial for every patient who needs a treatment of the aortic valve. There are other parts of heart surgery. Then you don’t need that balanced opinion. Perhaps a patient already received an expert opinion in some ways. A cardiologist might not able to place a coronary artery stent. Then a patient is referred for cardiac surgery. You have a feeling already that a conversation about all treatment options has occurred. But that is the most important thing for patients. Dr. Marc Pelletier, MD. They must know all their treatment options. A patient must have different physicians from multidisciplinary team to review all therapy options for their situation. A patient should have the best treatment option being given to them. Dr. Anton Titov, MD. A patient must consider all the options available. Then the best aortic valve stenosis treatment method must be selected for that particular patient. That is crucial to me.
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