In the United States, cardiovascular health is especially important. Heart disease is the leading cause of death in the U.S., and as many as 1.5 million people have been diagnosed with aortic stenosis (AS), with 500,000 of those patients having a severe form of the disease.
AS is a condition in which the aortic valve of the heart becomes narrowed, which keeps the valve from opening completely. This reduces blood flow to the rest of the body, making the heart work harder than normal. People diagnosed with severe AS have several treatment and surgery options, and it’s important to understand the differences so you can make the best decision with your cardiac care team about which one is best for you.
The Key Differences
While there are several ways to replace your aortic valve, TAVR and SAVR differ significantly in their approach and recovery. TAVR is a procedure, while SAVR is a surgery.
“There will be multi-disciplinary team discussions, which include interventional cardiologists and cardiac surgeons, to determine the best procedure based on age, risk factors, anatomic considerations, and type of valve disease,” says Sara Pereira, MD, a professor of surgery at University of Utah Health.
Transcatheter Aortic Valve Replacement (TAVR)
TAVR is a minimally invasive procedure that involves a catheter being inserted into an artery, without an incision for most cases, and then guided to the heart. The catheter delivers the new valve without the need for the chest or heart to be surgically opened.
Since TAVR is a non-surgical procedure, it has a much shorter recovery time. You will be monitored in the hospital for a day or two after surgery but will be able to walk, eat, and have visitors within six to eight hours. While it is important to speak with your physicians to determine when you can resume normal activities, most people are able to get back to their day-to-day lives one week after the procedure.
Some people will need blood thinners to prevent clots after the procedure. TAVR patients have a higher risk for needing a permanent pacemaker.
Surgical Aortic Valve Replacement (SAVR)
SAVR was the gold standard for aortic valve replacements before approval of transcatheter valves, according to Pereira. SAVR is a traditional, open-chest surgery where an incision is made to access the heart. The damaged valve is replaced, and the chest is surgically closed.
Since SAVR is a major surgery that involves an incision, recovery time is much longer. You will likely have to stay in the hospital for about a week, and at-home recovery may take four to 12 weeks.
Procedure Eligibility
TAVR was initially approved for people who were at high risk for open heart surgery. Since then, it has expanded to people at all levels of surgical risk.
However, TAVR is not recommended for everyone. Your heart team will consider several factors when deciding if you are a good candidate for TAVR, including:
- Overall heart health: People who have problems with more than one valve or have conditions such as aortic aneurysm or coronary artery disease may not be good candidates for TAVR.
- Valve condition: If your damaged valve has two leaflets instead of three, or is associated with an aneurysm or infection, you may not be a candidate for TAVR.
- Blood vessel size: TAVR may be unsafe if blood vessels, particularly the femoral artery, are too small to accommodate the thin catheter that must be guided to the heart.
- Overall physical health: While poor physical condition can make open-heart surgery risky or impossible, people with an infection or valve leakage should not undergo TAVR.
- Age: The ideal candidate for TAVR is older than 65, as tissue valves typically have a durability of about 15 years. The long-term durability of a TAVR valve is uncertain because it is a newer procedure.
“All of these issues are taken into consideration when deciding on the best valve type, valve operation, and best short- and long-term options for each patient,” Pereira says. “This is critically important and a true benefit of having a multi-disciplinary valve team.”