Key Takeaways
- Aortic stenosis hardens the body’s main artery, causing cardiovascular strain.
- Aortic valve stenosis threatens lives with its poor prognosis and concomitant conditions.
- In severe, symptomatic aortic stenosis, valve replacement is recommended and has been shown to improve life expectancy.
- Comorbidities complicate AS treatment and place some patients at high surgical risk.
- SAVR and TAVR have similar success and mortality rates, but TAVR typically shortens hospital stays, diminishes surgical trauma and improves recovery time.
An estimated 2.5 million Americans over 75 suffer from calcific aortic stenosis. Previously, the standard treatment for this life-threatening disease was surgical aortic valve replacement (SAVR). However, with comorbidities and the prevalence of inoperable conditions, physicians and patients wonder if minimally invasive procedures, like transcatheter aortic valve replacement (TAVR), should be the new standard of treatment.
Transcatheter aortic valve replacement, also known as transcatheter aortic valve implantation (TAVI), is a minimally invasive heart procedure used to treat aortic valve stenosis (AS). As the body’s main artery, the aorta is vital for heart health and blood flow. This one-way valve between the left ventricle and the aorta helps circulate oxygen to cells and tissue.
An ineffective valve leads to deficient circulation, increased cardiac strain and decreased oxygen supply. TAVR aims to restore adequate oxygenation and circulation while reducing the risk of cardiovascular complications.
Arteries and veins depend on valves to force blood in one direction. Aortic valve stenosis causes these valves to become thick and stiff due to calcification. This hardening of the valves prevents adequate opening and threatens blood flow. Severe stenosis causes the following symptoms:
Cardiologists and surgeons have relied on SAVR to treat patients with aortic stenosis. However, open-heart surgery is not always an option. Comorbidities and patients with complicating conditions, like lung or kidney disease, have increased surgical risks. Many providers consider TAVR a viable alternative to SAVR.
People with AS commonly suffer from other conditions that make treatment challenging. Poor prognosis and comorbidities necessitate team collaboration. Some common concomitant conditions that complicate AS therapy are the following:
Many cardiology teams find navigating patient care for aortic stenosis difficult. However, research indicates that TAVR is becoming the gold standard for valve replacement, especially for high-risk patients.
Using a catheter to transport a valve replacement from the insertion site to the heart, surgeons secure the new valve inside the opening of the old valve. The malfunctioning valve is pushed aside, and the pliable valve efficiently opens to promote adequate blood flow.
Typically, TAVR patients spend a night in the ICU for careful monitoring. Discharge times vary and depend on many factors. However, some patients are released the day after the procedure. Post-operative medications include anticoagulants and antibiotics. Follow-up appointments are vital to ensure the new valve is working correctly.
Medical providers understand that all procedures come with variable risks. The question becomes, “Do the benefits outweigh the risks?” Some risks associated with TAVR are the following:
The risks and benefits of TAVR and SAVR are similar. Both methods provide patients with a highly efficient and flexible aortic valve, generally improving circulation and diminishing symptoms. These procedures often prove to reduce strain on the vascular system. Typically, the TAVR method has the additional benefit of shorter hospital stays, decreased physical trauma and less recovery time.
Surgeons specialized in TAVR boast phenomenal procedural success rates. However, a procedural win is not the sole determinant of prognosis.
Research shows that at the 30-day mark, less than 9% of patients suffered from a stroke, myocardial infarction or other major vascular complication. A post-procedural pacing device may be necessary, and some degree of aortic paravalvular regurgitation commonly occurs. One study indicates less than 14% of TAVR patients experience moderate to severe paravalvular leakage.
Long-term mortality predictors were COPD, moderate to severe paravalvular aortic regurgitation and left ventricular ejection fraction (LVEF) of 30% or less. The only independent, procedural predictor of long-term mortality was a post-procedural stroke, which doubled the risk of death at the three and five-year marks.
The U.K. Transcatheter Aortic Valve Implantation Registry monitored TAVR mortality rates in patients with severe stenosis and poor prognosis. The initial data from the registry showed 30-day, 1-year, and 2-year survival rates post-TAVR as 92.9%, 78.6% and 73.6%, respectively.
When comparing SAVR to TAVR, debilitating stroke and mortality rates were similar. However, using the minimally invasive TAVR method for valve replacement typically decreases hospital stays, surgical trauma and recovery time. These and other factors establish TAVR as a long-term solution for safely and efficiently treating aortic stenosis.
With poor prognosis sans replacement, TAVR or SAVR is recommended for most symptomatic AS patients who show significant stenosis on echocardiography. However, many cardiology teams debate which method to implement. We are here to help.
“Five-Year Outcomes of Transcatheter or Surgical Aortic-Valve Replacement.” The New England Journal of Medicine, 2020 | NEJM.
“Long-Term Outcomes After Transcatheter Aortic Valve Replacement in High-Risk Patients with Severe Aortic Stenosis: The U.K. Transcatheter Aortic Valve Implantation Registry.” JACC: Cardiovascular Interventions, 2015 April, 27, ScienceDirect.
“Harold on History: The Evolution of Transcatheter Aortic Valve Replacement.” American College of Cardiology, 2017 July, 20.
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