The truth about TAVI: All that glitters is NOT gold. Minimally Invasive Aortic Valve Surgery and Replacement is still your best option. – Expert Heart Surgeon, Dr. Ciuffo
The Truth About Alternative Treatments for Aortic Stenosis
Misinformed consumers often makes very poor decisions. It is time to have an honest talk about trancatheter heart valve (THV) techniques and the FALSE assumption that they are as good as a surgical valve replacement.
After reading some of the material currently available on the internet or on local newspapers you are easily MISLED to believe that anybody could have an aortic valve easily and safely replaced by simply threading a catheter through the groin, same as it happens with a coronary stent.
I get quite a number of requests in that regard and here is what you need to know. Please read and use this information to discuss your options with your doctors and your family.
- THV is not approved by the FDA for treatment of aortic valve stenosis unless patients are a very high and prohibitive risk for a surgical AVR. There are good reasons for this restriction. Please understand that a surgical AVR is a much better and safer therapy than THV in the overwhelming majority of aortic valve disease cases. Most aortic stenosis patients in this country are treated surgically because of the following reasons:
- THV carries a risk of stroke that is up to four times higher than surgical AVR. For this reason, I do not know of any heart surgeon in good faith and in his right mind who would choose a THV rather than a surgical AVR for himself.
- There is no guarantee that the THV valve will last as long as the bioprosthetic valves currently used in surgical AVR. There are not sufficient follow up data to support that. We currently have decades of follow up data on most surgical prosthetic valves.
- THV has a much higher incidence of perivalvular leak (a leak between the THV valve and the implant site). On the other hand, this problem is exceedingly rare in surgical AVR’s
- If the groin arteries are small or heavily calcified, the risk of serious injuries when the THV catheter is deployed through them is high. A small femoral artery is actually a contraindication to THV
- THV has a higher mortality rate when compared to surgical AVR.
Minimally Invasive Aortic Valve Surgery
The idea to fix a valve with a catheter intervention sounds indeed attractive but it is definitely not the best option in most patients. The best and least invasive current option remains a minimally invasive AVR through a 2′ incision on the side of the chest in between the ribs, without breaking any bone, similar to the technique described in this webpage.
This is still the safest, least invasive and more definitive treatment available for aortic stenosis. Most patients are discharged home in the same or even less time it would take to send an uncomplicated THV patient home.
I hope this answers your comments. I do not have any specific clinical information about your individual case and how these principles would apply to any of you. I would advise you to always discuss your care with your doctors to decide what is best for you. Please feel free to contact me if I can help you with more information.