Your Heart Valve Options Explained: TAVR vs. Traditional Surgery

If severe aortic stenosis has you needing a new valve, you’ll likely hear about two options.

Surgical replacement means opening the chest and stopping the heart. Transcatheter aortic valve replacement (TAVR) delivers a new valve through a catheter while your heart keeps beating. 

Deciding between them involves your anatomy, age, surgical risk, and any other heart work you may need at the same time.

Board-certified interventional cardiologist Syed W. Bokhari, MD, FACC, FSVM, evaluates patients for aortic stenosis and TAVR at Advanced Cardiovascular Care, Inc. in Riverside, California.

How aortic stenosis impacts your heart

Your aortic valve controls blood flow from your heart into the aorta, the artery supplying the rest of your body. Aortic stenosis narrows that valve, forcing your heart to pump harder to move the same amount of blood. Over time, the strain thickens and weakens the heart muscle.

Severe stenosis typically causes symptoms such as:

• Chest pain or tightness
• Dizziness or fainting
• Shortness of breath
• Fatigue
• Rapid heartbeat

Mild to moderate stenosis may only need monitoring and healthy habits. Once symptoms appear alongside severe narrowing, valve replacement becomes the treatment that protects your heart from further damage.

Open-heart surgical aortic valve replacement (SAVR)

Surgical aortic valve replacement (SAVR) is the traditional approach. The surgeon opens the chest, typically through the breastbone, and places you on a heart-lung machine while the heart is stopped. They remove the damaged valve entirely and sew a new one into place.

Direct access gives the surgeon full visibility, which helps in complex situations. It also allows other work, such as bypass grafting or repair of a second valve, during the same operation. 

Recovery runs longer, with roughly a week in the hospital and several weeks to months before you’re back to full activity.

Transcatheter aortic valve replacement (TAVR)

TAVR replaces the valve through a catheter instead of an open chest. Dr. Bokhari makes a small incision, usually in the groin or chest, and threads a thin tube through your artery to your heart under X-ray guidance. The replacement valve travels through that catheter in a collapsed state.

Once inside your existing valve, the new valve expands, with a balloon or on its own, pushing aside the old, calcified valve. Your heart beats throughout, so you don’t need a heart-lung machine. Most patients receive sedation with local anesthesia rather than general anesthesia.

TAVR recovery time vs. open-heart surgery

After TAVR, most patients spend only 1 day in the hospital just for overnight monitoring and an echocardiogram the following morning. Many feel better within a week as the heart no longer has to contend with a narrowed valve. Restrictions on heavy lifting and strenuous activity last a few weeks.

Open surgery means about a week or two in the hospital and a longer road at home. Because the chestbone has to knit back together, activity restrictions stretch across weeks to months, and returning to full strength commonly takes 2-3 months.

Who qualifies as a TAVR candidate

TAVR initially received FDA approval for patients with surgical risk that’s too high, and its use has expanded considerably since. It tends to suit:

• TAVR is approved for ALL risk (low, intermediate and high) patients
• It is also approved for asymptomatic patients
• People with prior radiation, chest surgery or a fragile chest wall
• Patients with other conditions complicating open heart surgery
• Anatomy that accommodates catheter delivery

Avoiding a large chest incision and a heart-lung machine removes much of what makes open surgery difficult for these patients.

When valve replacement surgery is the stronger choice

For certain patients, open surgery remains the better option. It’s best for:

• Younger patients who were born with a congenitally abnormal bicuspid valve
• Anatomy unsuited to a transcatheter valve
• Patients needing bypass or another valve repaired at the same time
• Patients who need repair of their thoracic aorta

How a heart team chooses your procedure

Dr. Bokhari reviews imaging that measures your valve, your anatomy, and your coronary arteries, then discusses the findings with a hospital Heart Team that includes cardiac surgeons, cardiologists, anesthesiologists, radiologists and hospital staff.

That Heart Team weighs your age, life expectancy, other medical conditions, and your preferences. The goal is matching the procedure to your situation.

Aortic valve evaluation in Riverside, California

Choosing between TAVR and surgery starts with a clear picture of your valve and your health. To discuss your options, contact Advanced Cardiovascular Care, Inc. by phone at 951-682-6900, or request an appointment online today.