Treatment Approaches

Medications can be prescribed to patients with aortic valve disease to manage some symptoms; however, no medicine is available that can cure severe aortic valve disease. Two approaches-surgical or transcatheter- currently exist to replace diseased valves.

SAVR video click to view

TAVR video click to view

SAVR

Surgical aortic valve replacement (SAVR) is an open-chest surgery where the surgeon removes the diseased aortic valve and sews in a new one in its place. The heart is stopped during the surgery and blood pressure and oxygen levels are maintained with a heart-lung machine also known as cardiopulmonary bypass. Less invasive surgical techniques have been developed to allow the surgeon to perform this procedure through a smaller incision at the top or to the right side of the chest wall. Both metal (mechanical) and tissue valve prostheses can be inserted using a surgical approach.

TAVR

Transcatheter aortic valve replacement (TAVR) is a relatively new technique that allows implantation of a new valve through a very small incision in the leg or chest wall. Unlike a surgical aortic valve replacement, a TAVR procedure does not remove the diseased aortic valve – rather the old valve is pushed aside, opening space to place a new valve. Only tissue valve prostheses can be inserted using a transcatheter approach.

ELIGIBLE?

Am I a candidate for one or both of the aortic valve approaches?

The majority of patients are a candidate for both approaches. The presence of certain characteristics or conditions factors into the treatment approach recommendation.

SAVR

may be more appropriate for persons who have:

  • Active infections of the heart or heart valves requiring surgical removal
  • Multiple affected valves
  • Severe coronary artery disease that cannot be safely treated with stents and would require bypass surgery
  • Need replacement of the aorta in addition to the aortic valve
  • A strong case for needing a mechanical valve.

 

TAVR

may be more appropriate for persons who:

  • Are evaluated as too frail to undergo cardiopulmonary bypass surgery
  • Have a heavily calcified aorta ─ sometimes referred to as a “porcelain aorta”
  • Have a chest-wall deformity (this can be from prior trauma, prior surgery, or just the way you were born)
  • Have received chest radiation (‘high dose’ radiation for certain cancers can cause scarring in the chest that can make a surgical approach present a higher risk).
  • Have severe medical conditions that may make surgery to be a greater risk. Some examples are severe lung disease, various types of neurological disease, and poor kidney or liver function.

 

Common Complications or Issues

The major complications or issues associated with any valve replacement procedure are listed below:

  • Stroke
  • Kidney failure
  • Bleeding or vascular Injury
  • Arrhythmia (irregular heartbeat) such as atrial fibrillation
  • Heart block requiring a pacemaker
  • Postoperative ileus
  • Postoperative delirium (acute confusional state)
  • Prosthetic valve malfunction
  • Feeling emotional
  • Death

Complications of TAVR and SAVR are generally low. The expected frequency of these complications is determined by multiple factors, including the following:

  • State of your pre-surgical health and specific things about you that may increase the chance of a complication
  • Experience and skills of the surgeon and team performing your valve replacement and the generation and type of the valve and delivery system used
  • How the valve is placed (surgical versus transcatheter)

“I was teary in the weeks after my procedure. I spoke with another TAVR patient, a 70-year old former Marine, who called to check-in with me. He asked if I had been more emotional since the procedure, explaining that he had cried quite a bit and was more sensitive in the weeks after his procedure. It was such a relief to me to realize that I was having a normal, expected emotional response."

-- Susan Strong, Transcatheter
Aortic Valve Replacement Patient