TAVR vs. Open Heart Surgery: Choosing the Best Aortic Valve Replacement

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• Treatment Options for Aortic Stenosis
• Multidisciplinary Team Assessment
• Potential Bias in Treatment Recommendation
• Tailoring Procedure to Individual Patient
• Patient Role in Decision Making
• Full Transcript

Treatment Options for Aortic Stenosis

Patients with severe aortic stenosis have two primary treatment options for aortic valve replacement. The traditional method is open heart surgery. The newer, minimally invasive procedure is transcatheter aortic valve replacement, known as TAVR or TAVI. Dr. Marc Pelletier, MD, notes that TAVR offers a significantly faster recovery time for many patients. This is a major consideration when weighing the risks and benefits of each procedure.

Dr. Anton Titov, MD, discusses the importance of understanding how well the new aortic valve will function after the procedure. Both TAVR and surgical aortic valve replacement are highly effective, but the choice depends on individual patient factors.

Multidisciplinary Team Assessment

The optimal method for deciding on treatment is assessment by a comprehensive heart team. Dr. Marc Pelletier, MD, stresses that this multidisciplinary team is crucial for a fair evaluation. An ideal team includes a cardiac surgeon, an interventional cardiologist, a non-interventional cardiologist, and a TAVR coordinator.

Dr. Marc Pelletier, MD, explains that such clinics provide a holistic view of the patient's condition. This collaborative approach ensures all perspectives are considered before recommending a course of action.

Potential Bias in Treatment Recommendation

A significant problem arises when a patient consults a specialist who only performs one type of procedure. Dr. Marc Pelletier, MD, points out that a surgeon unfamiliar with TAVR may have an inherent bias toward open heart surgery. Conversely, an interventional cardiologist who only performs TAVR may be biased toward that minimally invasive approach.

This single-specialty viewpoint can limit a patient's understanding of all available options. Dr. Anton Titov, MD, and Dr. Pelletier agree that a balanced opinion is essential for making an informed decision.

Tailoring Procedure to Individual Patient

The two aortic valve replacement procedures are very equal in many outcomes. However, specific patient factors determine which procedure offers the best results. Dr. Marc Pelletier, MD, states that some patients will do much better with TAVR, while others are better suited for traditional open heart surgery.

Factors like age, overall health, anatomy, and surgical risk scores guide this decision. The goal is to match the patient with the procedure that provides the highest success rate and best quality of life.

Patient Role in Decision Making

Dr. Marc Pelletier, MD, believes it is absolutely crucial for patients to know all their treatment options. Patients must be active participants in their care and understand the rationale behind a treatment recommendation. A conversation reviewing all therapy options is the most important step for any patient facing aortic valve surgery.

Dr. Anton Titov, MD, concludes that the best treatment method must be selected for that particular patient's unique situation. This patient-centered approach ensures the highest standard of care and the best possible outcome.

Full Transcript

Dr. Anton Titov, MD: How to choose between open heart surgery to replace the aortic valve and the new minimally invasive transcatheter aortic valve replacement (TAVR, TAVI, implantation)? Aortic valve replacement by TAVR or open heart aortic valve replacement surgery? A patient comes to a surgeon, and the surgeon says, "You could be suitable for the classic aortic valve replacement by open-heart surgery, but we also could do this new procedure, TAVR. We could do both methods to replace your aortic heart valve."

Dr. Anton Titov, MD: How would a patient weigh the risks of TAVR vs. open heart surgery? How well will the aortic valve function after TAVR?

Dr. Marc Pelletier, MD: Recovery after the TAVI/TAVR is much faster. Transcatheter aortic valve replacement is minimally invasive.

Dr. Anton Titov, MD: What are other considerations that a patient with aortic stenosis should think about?

It's really important for aortic stenosis patients to get a good idea of what their treatment options are. The best method to do that is to be assessed by a surgeon. The surgeon has to be part of a comprehensive heart treatment team.

Dr. Marc Pelletier, MD: There are surgeons who are doing transcatheter aortic valve replacement. They are really linked into a comprehensive heart therapy team. This involves a non-interventional cardiologist, an interventional cardiologist, a surgeon, and a TAVR coordinator. We run such clinics here at our hospital. There are many other centers that do it as well.

That is really the best method: a multidisciplinary team that makes a fair assessment of the best heart disease treatment procedure for a patient. Multidisciplinary team assessment.

Dr. Marc Pelletier, MD: Yes. The problem sometimes is this: a patient with aortic stenosis sees a surgeon who has never done a TAVI. Some cardiac surgeons have no involvement with TAVI. That surgeon will inherently have a bias about what treatment that patient should have.

In a similar fashion, an opposite situation may happen. A patient with aortic stenosis may see a surgeon or a cardiologist who only does TAVI/TAVR. They never do open heart surgery. They would have also the same type of bias towards the TAVR/TAVI procedure.

The two aortic valve replacement procedures are very equal on many levels. But there are some patients that do much better with one type of aortic valve replacement procedure. Other patients with aortic stenosis do better with another type of aortic valve replacement procedure.

Dr. Anton Titov, MD: It is best to get a fair and balanced opinion from somebody who's part of a comprehensive heart team.

Dr. Marc Pelletier, MD: This to me is absolutely crucial. It is crucial for every patient who needs treatment of the aortic valve. There are other parts of heart surgery where you don't need that balanced opinion. Perhaps a patient already received an expert opinion in some ways.

A cardiologist might not be able to place a coronary artery stent, then a patient is referred for cardiac surgery. You have a feeling already that a conversation about all treatment options has occurred. But that is the most important thing for patients.

Dr. Marc Pelletier, MD: They must know all their treatment options. A patient must have different physicians from a multidisciplinary team review all therapy options for their situation. A patient should have the best treatment option given to them.

Dr. Anton Titov, MD: A patient must consider all the options available. Then the best aortic valve stenosis treatment method must be selected for that particular patient. That is crucial to me.