As we are all aware, the pumping of blood from the heart to rest of the body, and vice-versa, is regulated by valves present in the four chambers of the heart. Oxygenated blood that has come in from the lungs is pumped out to the rest of the body through a large artery called the aorta. This mechanism is regulated by the aortic valve that ensures the blood does not fall back and is moving forward. The aortic valve is made up of three flaps called leaflets that work in sync for this action.
In some people, with time, calcium starts depositing in these leaflets, causing them to harden or thicken. As a result, the aortic valve does not open properly or the opening gets narrowed down, which affects the blood flow. The condition is called aortic stenosis. Patients suffering from the condition experience shortness of breath, chest pain, heart murmur and palpitations. Till the early 2011-12, the only solution to resolve aortic stenosis was an open-heart surgery to remove the defective valve and replace with a new one.
But research and experiments being conducted, on alternate treatments, has resulted in a new procedure called Transcatheter Aortic Valve Replacement (TAVR). TAVR is available since 2012. TAVR was necessitated by the fact that many patients with aortic stenosis are not good candidates for open-heart surgery. Either due to advanced age or other ailments, which prevent them from bearing the strain of an incisional surgery.
Both procedures come with their own pros and cons, as described below.
As the name implies, in open-heart surgery, the surgeon is cutting into the sternum (chest wall) and then the heart, to access the defective valve. The patient is on general anaesthesia then. In contrast, TAVR is a minimally invasive procedure. A small incision is made in the groin and a catheter inserted into it. It is then threaded through the femoral artery all the way to the site of the valve. A second catheter that is inserted inside the first carries the new valve and a balloon at its tip. The new valve is pushed into position, which in turn pushes the old valve to the side. The balloon is inflated to lock the new valve in place. Once locked in place, the balloon is deflated and the two catheters are withdrawn. The person is on sedatives throughout.
As mentioned before, TAVR has emerged because some patients of aortic stenosis are not good candidates for open-heart surgery due to their advanced age, or pre-existing conditions which puts them at the risk of mortality or stroke. In contrast, TAVR is suitable for people who are both at risk or low-risk for open-surgery. However, TAVR is not suitable for people with defects in the structure or anatomy of their heart valves. A qualified cardiac surgeon will evaluate your and your family’s medical history to decide which procedure is right for you.
SAVR (Surgical Aortic Valve Replacement) requires a week to 10 days of hospitalization where the person’s cardiac and overall health parameters are constantly monitored to rule out side-effects and complications. In contrast, TAVR may require 2-3 days of hospitalization.
Incisional surgery certainly leaves a scar, which can only be erased by cosmetic surgery. In contrast, in TAVR, since the catheter is inserted into the groin, the scar is small and not visible to the outside world. Plus the fact that it heals faster.
Pain is a clear outcome of open-heart surgery as there is trauma to the chest and heart wall tissues. In contrast, there is very mild pain and discomfort after a TAVR and the pain subsides very quickly. In rare cases, a painkiller may be prescribed.
With open-heart surgery, the person will take a couple of months to get back to a normal life. There are various restrictions around diet and activity. In case there have been some complications due to the procedure; there will be medication along with whatever medication you are taking for pre-existing ailments. With TAVR, things are simpler. The doctor will prescribe medicines for the heart and to manage the pain. He/she will advise you on rest, activity and how to take care of the wound or keep it dry. The person can get back to a normal life in a week to 10 days time.
Some times, the procedure may not yield the best outcome for some people. Or there may be complications over time. Both these will require re-intervention to address the issue. While the replaced valves last 10 to 15 years, some condition(s) may cause replacing of the valve again, in both the procedures.
Despite the above fact, mortality rates subsequent to the procedure are lower with TAVR than open-heart surgery. Even more so if the TAVR is transfemoral as against TAVR through an incision in the chest area.
Both procedures come with their own share of risks and complications. Complications from open-surgery include irregular heartbeat, heart attack or stroke, chest pain, low fever, breathing difficulty, pneumonia, lung or kidney failure, blood clot, blood loss and memory loss or fuzziness. Such patients may also suffer from chest wound infection, especially if they are obese, diabetic or have had a bypass surgery before. With TAVR, the complications include infection, stroke, kidney disease, blood vessel complications, problems with the valve itself, heart attack and heart-rhythm abnormalities. But please note; doctors are aware of these and know how to deal with them.
TAVR has emerged as an excellent treatment option for people with aortic stenosis. It offers hope to millions of patients with this condition, who are not eligible for open-heart surgery due to various reasons. If you or any of your dear ones are diagnosed with aortic stenosis, do not panic. Consult a reputed hospital. Cardiologists there will evaluate your condition thoroughly and choose the best option for long-term health.
1. What is aortic stenosis?
Aortic stenosis is a condition where calcium deposits cause narrowing or hardening of the aortic valve, affecting blood flow from the heart to the body.
2. What is TAVR?
TAVR (Transcatheter Aortic Valve Replacement) is a minimally invasive procedure to replace a defective aortic valve using a catheter inserted through the groin.
3. Who is eligible for TAVR?
TAVR is suitable for people at risk or low risk for open-heart surgery, but not for those with certain heart valve defects.
4. What are the differences between TAVR and open-heart surgery?
TAVR involves a smaller incision, shorter hospitalization, faster recovery, and less visible scarring compared to open-heart surgery.
5. What are the risks and complications of TAVR?
Complications of TAVR may include infection, stroke, kidney disease, blood vessel issues, and heart rhythm abnormalities, but doctors are equipped to manage them.
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.
Chennai – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801
NOTE: Take medications only when prescribed by your doctors, self-medication must be avoided under any circumstances.
Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals
