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• Introduction
• How Do Risks Differ Between TAVR and Open-Heart Surgery?
• Survival and Stroke Risk
• Patient Comfort and Recovery
• Advantages of Open-Heart Surgery
• Technical Considerations and Uncertainties in TAVR
• What About Low-Risk Patients?
• Conclusion

Introduction

Aortic valve replacement can be performed using two primary approaches: traditional open-heart surgery and the less invasive transcatheter aortic valve replacement (TAVR), also known as TAVI. In this discussion, Dr. Marc Pelletier and Dr. Anton Titov explore the differences in risks and benefits between these procedures.

How Do Risks Differ Between TAVR and Open-Heart Surgery?

Patients often ask whether TAVR is a better option than open-heart surgery. The answer depends on individual health status and procedural goals. While both procedures aim to replace a dysfunctional aortic valve, their risk profiles vary in meaningful ways.

Survival and Stroke Risk

For patients at intermediate or higher surgical risk, survival rates between TAVR and open-heart surgery are quite similar. Likewise, the risk of stroke is comparable between the two procedures, with TAVR sometimes slightly higher or lower depending on the patient group.

Patient Comfort and Recovery

TAVR typically offers a superior recovery experience. Patients often return to daily activities, including work and exercise, much more quickly compared to open-heart surgery. TAVR involves smaller incisions, less scarring, and less post-procedural discomfort.

Additionally, patients undergoing TAVR have a reduced need for blood transfusions and a lower risk of developing atrial fibrillation after the procedure.

Advantages of Open-Heart Surgery

Despite the appeal of TAVR, open-heart surgery has advantages, particularly in terms of procedural predictability and valve performance.

Surgical valve placement allows direct visualization of the operative field, offering surgeons greater control. Valve function is more predictable, and the risk of valve leakage post-surgery is nearly zero, whereas TAVR carries a 3% to 5% chance of minor valve leak.

Furthermore, surgical valves have a well-established track record of long-term durability. The longevity of TAVR valves is still being studied.

Technical Considerations and Uncertainties in TAVR

TAVR involves some unpredictability during valve deployment. Physicians must consider how the new valve interacts with the old one, and whether it will seat correctly without obstructing the coronary arteries. These factors introduce a level of uncertainty not present in open surgery.

What About Low-Risk Patients?

The optimal procedure for low-risk, otherwise healthy patients is still under investigation. Ongoing clinical trials will provide more data on whether TAVR or open-heart surgery offers better outcomes for this group.

Conclusion

TAVR and open-heart surgery both offer life-saving benefits for patients with aortic stenosis. The choice between them depends on individual risk factors, anatomy, and personal preferences. As data from current trials emerge, physicians and patients will be better equipped to make informed decisions.