Open Heart Surgery May Not Be Your Only Option

Thousands of patients suffering from failing aortic valves, may not need to undergo open heart surgery. A procedure known as transcatheter aortic valve replacement (TAVR) has up until now, been reserved for patients that may otherwise not survive open-heart surgery, however, two large clinical trials are now showing that TAVR may also benefit younger and healthier patients too. This may be an alternative to avoid open heart surgery.

There are many risks associated with open heart surgery, the procedure itself requires the ribs to be spread apart, often times a heart-lung bypass machine is used to move the blood away from the heart so that it is essentially ‘stopped’ to create a new aortic valve. This procedure is both stressful and traumatic for the body, and risks include [1]:

• Chest wound infection
• Heart attack or stroke
• Irregular heartbeat
• Lung or kidney failure
• Blood clots
• Blood loss
• Breathing difficulty
• Pneumonia

Findings that TAVR may be the new approach to avoid heart surgery are truly remarkable.

This minimally invasive surgical procedure repairs the heart valve without removing the old, damaged valve. Only one incision is made in the groin, and recovery takes only 3-5 days. TAVR may also decrease the risk of disabling strokes and death when compared to heart surgery. This may change the course of action for most patients with failing aortic valves [2].

WHAT IS TAVR?

In this procedure, a collapsible aortic heart valve known as an Edwards valve is introduced to the body through a catheter-based delivery system. This valve is designed to replace the patient’s problematic aortic valve. The Edwards valve is compressed onto a balloon catheter which is pushed through a blood vessel from the groin to the aorta. Once it reaches the aorta, a cardiologist inflates the balloon, which expands the valve, and pushes aside the failing valve.

This new approach is less invasive than traditional surgery [3], where the old valve is cut out and a new valve is sewn in.

This procedure has us questioning why we should get surgery when TAVR offers decreased risks. Rates of death, disabling stroke and hospitalizations at one year following the procedure are 15% with heart surgery versus 8.5% with TAVR [4]. Longer-term outcomes estimated deaths or disabling strokes after the two-year mark at  6.7% for surgery versus 5.3% with TAVR, which was not considered statistically significant [5]. However, in the short term, TVAR was considered significantly safer at the 30-day mark, where the rate of death or disabling stroke was at 0.8% versus 2.4% for surgery [5].

The Food and Drug Administration is expected to approve this procedure for lower-risk patients. This could equate to 20,000 patients per year being eligible for TAVR, in addition to the nearly 60,000 intermediate- and high-risk patients who get could have the operation now. The procedure is more expensive than a standard valve replacement, however, shorter hospital stays and recovery times are said to make up for it.

This procedure is not for everyone, some healthier patients will still be recommended traditional surgery, such as those born a bicuspid aortic valve. At this time, most patients will be able to decide on which procedure they choose – TAVR or surgery.

In the end, there is no arguing that prevention is the best medicine. Living a lifestyle that can help prevent us from going under the knife, invasively or less so, just makes sense. However, sometimes more intensive measures such as surgery are needed. We’re all just doing the best we can.