A new or unexpected diagnosis of a failing aortic valve can be stressful and frightening.  More than anything, the fear often comes from not knowing the next steps for the optimal treatment of life-threatening diseases including aortic stenosis. However, Patients should know that, during the past 50 years, aortic valve surgery has greatly advanced. There are many treatment options that are safe and effective with minimal risk.

For example, there are minimally-invasive transcatheter aortic valve replacement (TAVR) procedures to treat aortic stenosis. While TAVR was initially designed for older, higher-risk patients, this revolutionary therapy is now acceptable for low-risk patients who often go home just one day after the procedure. There are also surgical aortic valve replacement (SAVR) approaches which require an incision to the patient’s chest or ribs. While the recovery from SAVR is longer, this may be a better option for younger patients for various reasons. As some of you know, I had a Ross Procedure nearly 20 years ago, which has worked out very well for me as I have not needed a re-operation.

One thing is for sure, there is no shortage of questions when it comes to aortic valve replacement. That’s why I was thrilled when Dr. Joanna Chikwe, Chair of Cardiac Surgery at Cedars-Sinai Medical Center, agreed to share her experience and insights about what patients need to know about TAVR and SAVR in the setting of heart valve surgery today.

Key Learnings About TAVR vs. SAVR in 2024

Here are important insights shared by Dr. Chikwe during our interview:

• The use of TAVR to treat aortic stenosis has grown significantly during the past 10 years. During 2023, there were over 100,000 TAVR procedures performed which is an exponential increase from the 4,000 TAVR procedures performed in 2012, according to The Society of Thoracic Surgeons.

• TAVR is a safe and effective procedure typically used on older patients while SAVR is often used on younger patients. “TAVR, absolutely a great solution for older patients with tight aortic stenosis; super safe,” said Dr. Chikwe. “Surgery becomes a really important option for younger patients because they need lifelong solutions.”

• For younger patients, there are many options for the surgical treatment of aortic valve disease. Those therapies may include different types of SAVR including aortic valve repair, valve-sparing, and the Ross Procedure which enable patients to keep their own valve tissue. In addition, patients may opt for a mechanical heart valve replacement. “We want to think about better solutions,” Dr. Chikwe states. “For patients in their 20s, 30s, and 40s, we always talk about Ross procedure. That can give people the best freedom from the need for medications and other procedures. Some patients might be suitable for mechanical valve replacements. That’s not something we can do through a catheter.”

• Aortic valve patients with other cardiac conditions including aneurysms, atrial fibrillation and coronary artery disease need to be made aware of the opportunities and constraints for concomitant treatment. Dr. Chikwe states, “There are patients who have aneurysmal disease of the aorta and need a very specific and different approach because a TAVR isn’t the safest option for them.”

• When deciding on a valve replacement, planning what might happen in the future is necessary. Chikwe told us that planning for the future is a key part of the decision-making process. “We map out the implications of having a mechanical valve and needing anticoagulation, the long-term stroke risk, and the risk of re-operation,” she said. “If we choose to place a tissue valve, how can we set that patient up for success through potentially more than one procedure?”

• A tissue valve replacement provides patients more options if future aortic valve interventions are required including a surgical re-replacement. Dr. Chikwe shared that, in terms of having a tissue valve replacement, it’s much better to be able to plan for a redo aortic valve surgery down the road. Even though another surgery may mean a patient will have a four or five-day hospital stay, it is a low-risk solution and much better than suffering the devastating complications of anticoagulation and stroke that can sometimes go along with a mechanical valve.

Thanks Dr. Chikwe and Cedars-Sinai Medical Center!

Thank you, Dr. Chikwe, for everything you and your team at Cedars-Sinai Medical Center in Los Angeles are doing for heart valve patients across the world!

Related links:

• See 50+ Patient Reviews for Dr. Chikwe
• Surgeon Q&A: How Is The Heart Stopped During Cardiac Surgery?
• Life Expectancy & Heart Valve Surgery: What Should You Know?

Keep on tickin!
Adam

P.S. For the deaf and hard-of-hearing members of our community, I have provided a written transcript of this video below.