According to the American Heart Association, aortic stenosis (AS) is the most common type of heart valve disease and affects about 20% of older Americans.
For years, the only treatment for severe AS was open-heart surgery or surgical aortic valve replacement (SAVR). Then, in 2012, the FDA approved a new treatment called transcatheter aortic valve replacement (TAVR). TAVR is minimally invasive and may be an option for patients who cannot have open-heart surgery.
This post will explore the differences between TAVR and open-heart surgery, including when each is recommended, and how to talk to your provider about whats right for you.
What Is Aortic Stenosis
Aortic stenosis is caused by calcium build-up on the leaflets of the aortic valve, leading to valve stiffness and improper opening. Symptoms of aortic stenosis include:
- Fatigue
- Shortness of breath
- Chest pain
- Rapid fluttering heartbeat
Aortic stenosis is a progressive condition, meaning it worsens over time. In the mild or moderate stages, patients will work with their care team to manage symptoms and delay further damage to the valve through medication and lifestyle changes. When aortic stenosis reaches the severe stage, your doctor may recommend either open-heart surgery or TAVR.
TAVR vs. Open-Heart Surgery
Before deciding between TAVR and open-heart surgery, it is important to consider your overall health and age, as they may affect your eligibility for one treatment or the other. The following information can help you understand some of the key differences between TAVR and open-heart surgery.
How it Works: TAVR
- Your care team will give you medication to either put you fully to sleep or sedate you.
- Your surgeon will make a small cut into your groin and insert a thin tube (catheter) into your femoral artery.
- The new valve is placed on a tube with a balloon at the end and travels up the tube until it reaches your heart.
- The balloon is inflated, expanding the replacement valve and pushing aside your diseased valve.
- Once placed, the balloon is deflated and removed along with the catheter.
- Your surgeon will close up the tiny incision on your groin.
How long does it take? The average TAVR procedure takes about one hour.
Whats the average hospital stay? After the procedure, the average hospital stay is between two and five days.
What happens after TAVR? While in the hospital, your care team will monitor your hearts rhythm, conduct physical exams and perform diagnostic tests like a chest x-ray and blood tests to ensure your new valve is functioning properly. You may also meet with a physical therapist to help you get up and moving.
After discharge, you may be required to take blood-thinning medicine for up to six months and begin an aspirin regimen. Your recovery plan will also include lifestyle guidelines to support your recovery. Youll check in frequently with your doctor in the weeks, months and years after TAVR.
What is recovery like? After TAVR, your doctor will give you instructions on rest, activity and how to care for your incision. Most TAVR patients are back to living normally after about ten days.
What are the risks? As with any medical procedure, TAVR isnt risk-free. Risks include:
- Bleeding
- Infection
- Stroke
- Blood vessel problems
- Valve placement problems
- Kidney disease
- Heart attack
- Death
How It Works: Open Heart Surgery
- Your care team will give you medication to put you to sleep.
- Youll be connected to a heart-lung machine that diverts blood flow and temporarily stops your heart.
- Your surgeon will make a six-inch cut through your breastbone to access your heart.
- After removing the damaged valve, your surgeon will place a new one.
- Once the new valve is working, your surgeon will take you off the heart-lung machine, place tubes around your heart to drain fluid build-up, and close your breastbone with stainless steel wires.
- Finally, your surgeon will close the incision with stitches.
How long does it take? The average open-heart surgery takes between four and six hours.
Whats the average hospital stay? Open-heart surgery patients will stay in the ICU for a day or two after surgery and in a step-down unit for a week or so, depending on their recovery.
What happens after open-heart surgery? In the ICU, your care team will closely monitor your heart, blood pressure, oxygen level and vital signs. After youre transferred to a step-down unit, the staff will continue to monitor your progress and help you start to move.
After discharge, youll receive your doctor’s recovery guidelines, including medications and lifestyle changes to support your recovery. Youll check in frequently with your doctor in the weeks, months and years after open-heart surgery.
What is recovery like? Recovery from open-heart surgery generally takes longer than TAVR due to the invasive nature of the procedure. It may take a few months to return to your normal routine.
What are the risks? Risks of open-heart surgery include:
- Bleeding
- Blood clots
- Stroke
- Replacement valve failure
- Heart rhythm problems
- Infection
- Death
Which Option Is Right For You?
Age is one of the primary factors in determining whether youll undergo open-heart surgery or TAVR. The AHA recommends all patients over 80 opt for the less invasive TAVR, while patients over 65 may choose open-heart surgery or TAVR. But age is only one factor. Others include:
- Your medical history
- Your current health
- The condition of your heart and the progression of AS
- Whether youre able to undergo and recover from the procedure safely
Some patients may not be candidates for open-heart surgery due to other health factors like lung or kidney disease, which could make the procedure too risky.
While some doctors recommend all patients who could qualify for open-heart surgery choose that option, TAVR has advanced to the point where many providers are comfortable recommending it more broadly as a less invasive alternative to open-heart surgery.
No two valve replacement cases are the same. The decision should be made in consultation with your doctor to ensure the best possible outcome for your health and well-being.
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