Transcatheter Aortic Valve Replacement (TAVR): Changing the paradigm for the treatment of aortic stenosis

One of the latest treatment options for aortic valve replacement surgery is Transcatheter Aortic Valve Replacement (TAVR) surgery.  TAVR involves fixing a valve that has become “stenotic” (blocked) by using catheters and wires to place an artificial valve inside of the diseased valve.  At present, there is only one TAVR device commercially available, in the United States, for implantation: the Edwards Lifesciences Sapien Valve.  The Medtronic CoreValve is also available in the United States, but only as part of a clinical trial.

Advantages of TAVR

  • One of the main advantages to this procedure is that it avoids cutting of the sternum (breastbone) and provides for quicker recovery from the procedure.  Another advantages of TAVR surgery is that this procedure avoids the need for cardiopulmonary bypass, or heart lung machine.

    Transcatheter Aortic Valve Replacement (TAVR)

    Photo Credit: Wikimedia.org

  • Considering that there is not physical trauma to the patient’s sternum or rib cage during TAVR surgery, recovery is faster, hospital stays are shorter and the patient will be able to resume their normal life within just a few days after the procedure though some post surgery care is essential.
  • Another theoretical advantage of catheter based valve replacement surgery is the belief that infection rates will be less that traditional open-heart surgery.

Disadvantages of Transcatheter Aortic Valve Replacement

  • The main disadvantage of the TAVR procedures, however, is the risk of stroke caused by blood clots during and after the procedure.  As select reports have alluded to, TAVR increases the risk of stroke and vascular complications when compared to traditional heart valve replacement approaches.
  • With some of the devices, the risk of having to have a pacemaker is also increased.
  • As the technology for TAVR is new, not many places perform TAVR procedures yet.  Finding an experienced surgeon and interventional cardiologist that specialize in TAVR could be a challenging task, however, most cardiovascular professionals are capable of performing the necessary testing to determine if someone is a suitable candidate for TAVR, even if they do not themselves perform the procedure.

The choice of approach needs to be assessed on an individual basis.

  • While deciding on the right approach for aortic valve replacement, a number of factors need to be taken into account such as the age of the patient, general health condition of the patient, availability of the medical facilities and equipment to perform the procedure, required skills and expertise to perform the procedure, etc.
  • Currently, to be eligible for the TAVR procedure outside of a clinical trial, patients must have been deemed “inoperable” by a surgeon and have met a number of anatomic considerations that satisfy requirements for safe deployment of the device.

All of these factors vary from case to case and the decision on the choice of the surgical procedure should be carefully considered by healthcare professionals with special skills and training, in consultation with each individual patient.

 

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