Many aortic valve stenosis patients come to me with the false assumption that transcatheter heart valve treatments are preferable to minimally invasive surgical aortic valve replacements. We want to set the record straight that the very best option for most patients is the minimally invasive heart valve replacement. THV treatments come with a large set of risks and is much more dangerous than surgical aortic valve replacements.
- 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.
Surgical aortic valve replacement is a much better and safer therapy than transcatheter heart valve surgery in the overwhelming majority of aortic valve disease cases.
- 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 valve used in transcatheter heart valve surgery will last as long as the bioprosthetic valves currently used in surgical methods.
There are not sufficient follow up data to support how long the valve will last with THV. 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).
In surgical aortic valve replacement, perivalvular leaks are extremely rare.
- If the groin arteries are small or heavily calcified, the risk of serious injuries when the THV catheter is deployed through them is high.
- THV has a higher mortality rate when compared to surgical AVR.
Minimally Invasive Aortic Valve Replacement
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 bones.
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.