Replacing Your Aortic Valve: SAVR vs TAVI
If you’re suffering from severe aortic stenosis (a narrowing of the aortic valve that impedes blood flow to the heart), you are likely experiencing some uncomfortable and even painful symptoms. In order to relieve some of these symptoms and get you back on the road to health, your doctor may recommend replacing your aortic valve. There are two main types of aortic valve replacement options. While SAVR (surgical aortic valve replacement) was the first method developed more than fifty years ago, a less invasive option called TAVI (transcatheter aortic valve implantation) has gained ground in recent years. Both have proven to be effective, but one may be a better option than the other depending on your medical situation. Learn more about the similarities and differences below.
Surgical aortic valve replacement (SAVR)
Surgical aortic valve replacement (SAVR) is a procedure in which the diseased aortic valve is replaced through open heart surgery. During SAVR, the patient is put under a general anesthetic. The surgeon then makes an incision in the chest to access the heart, the length of which depends on the surgical approach. Next, the heart is stopped, and the patient is placed on a heart-lung machine, which does the work for the heart while it is stopped. The surgeon then removes the diseased valve and replaces it with an artificial valve. After the valve is replaced, the heart is restarted and the incision is closed.
After the procedure, the patient usually spends one to two days in the intensive care unit (ICU) and up to a week in the hospital to monitor for complications. Chest incision healing can take anywhere from four to eight weeks, and total recovery can take up to three months after the surgery.
SAVR has risks and potential complications, just as any other major surgery. These include blood clots, bleeding, infection, irregular heartbeats, and stroke.
Transcatheter aortic valve implantation (TAVI)
Transcatheter aortic valve implantation (TAVI) is minimally invasive and doesn’t typically require open heart surgery or incisions in the chest. During a TAVI procedure, the diseased aortic valve is replaced with an artificial valve using a catheter. A catheter is a thin, flexible tube that can be inserted into a blood vessel and threaded to the heart. During TAVI, the artificial valve is delivered to the heart through the catheter using a special x-ray. Instead of removing the diseased valve, the artificial valve pushes the leaflets of the diseased valve aside and takes over control of blood flow. Patients are usually sedated, but awake, and the procedure often takes less than an hour.
The recovery process for TAVI is typically faster than SAVR. Some patients can go home within a day or two, and can return to normal activities within weeks. In both TAVI and SAVR procedures, recovery time is variable and depends on each individual’s situation.
TAVI carries many of the same risks as SAVR, including stroke. As the catheter moves through the blood vessel to the heart, calcium, tissue and other organic or foreign matter (called embolic debris) can break loose and enter the bloodstream. This debris has the potential to travel to the brain, which may cause a stroke or neurological damage.
However, during a TAVI procedure, patients may have the option of using an embolic protection system that can catch and remove this debris before it reaches the brain. The Sentinel® Cerebral Protection device is the only embolic protection system currently approved for use in the U.S., and using it during TAVI may reduce the risk of stroke by up to 70% during and after the procedure. If you or a loved one will be undergoing TAVR, ask your Heart Team if embolic protection is an option for you.
Which is Right for You?
While it’s important to be educated about your condition and treatment options, your doctor will evaluate your situation and recommend the valve replacement option that is best for you. The severity of the condition, your overall health, medical history, other cardiac issues, and age will all be considered when determining whether SAVR or TAVI is the right course of action. In either case, replacing your aortic valve will hopefully lead to symptom relief and a better quality of life.
- The Columbia Aortic Center. Available at: http://columbiaheartvalve.org/aortic-valve-treatment. Accessed December 7, 2017.
- US News and World Report: What to Know About TAVR, an Alternative to Open Heart Surgery. Available at: https://health.usnews.com/health-care/patient-advice/articles/2017-09-18/what-to-know-about-tavr-an-alternative-to-open-heart-surgery. Accessed December 7, 2017.