It wasn’t long ago that people with aortic stenosis only had one option: surgical aortic valve replacement (SAVR) with a new mechanical or bioprosthetic valve. Over the past twenty years, however, we’ve seen significant progress and technological advancements in minimally-invasive aortic valve replacement, most notably, transcatheter aortic valve replacement (TAVR).

The innovations we’re experiencing now are incredible, but they also create questions and potential uncertainty for anyone receiving news that they require an aortic valve replacement in the coming weeks or months ahead. When I had the opportunity to speak with Dr. G. Michael Deeb, the Inaugural Herbert Sloan Professor of Cardiac Surgery at the University of Michigan Health in Ann Arbor, Michigan, I was thrilled to ask him the most pressing questions about SAVR and TAVR coming from our patient community.

Dr. Deeb’s Key Learnings About TAVR

Here are important insights that Dr. Deeb shared with our community:

• With the tremendous growth in TAVR and over 100,000¹ procedures already performed, I asked Dr. Deeb about the differences between TAVR and SAVR. “The biggest difference is the amount of trauma the patient experiences,” he said. “Whether fully invasive, partially invasive, or minimally invasive, open heart surgery is an open heart.” With that, Dr. Deeb described TAVR as a minimally-invasive puncture at typically in the groin (not an incision to the chest), and the medical team is not required to stop the heart during TAVR. The medical team watches images on a video screen as they pass a wire up through the artery. “The wire is like a railroad track,” Dr. Deeb said. “Over that wire, we have a hollow catheter as big as my finger; that’s the train. Then we have the valve, which is the passenger. The valve is in a circular wire frame, and inside are three leaflets made from the heart of a cow or a pig. As the valve is compressed, we slide it up and release it. It pushes the old valve up and away, and the old valve is never removed.” Like most procedures, there are risks to TAVR which may include, but are not limited to, death, stroke, damage to the arteries, bleeding and need for permanent pacemaker.

• Next, Dr. Deeb talked about the best candidates for TAVR. He told us that TAVR was initially only for older patients who couldn’t undergo the trauma of open-heart surgery. As time passed, TAVR was successful for the older patient population who were high surgical risk². Before long, they were performing TAVR on intermediate-risk patients, and now, low-risk patients are also having the procedure. “Risk has nothing to do with it now,” he said. “It all has to do with lifetime management. When I see you, and you need an aortic valve, I look at your age, your medical condition, and how I can get you back on the normal survival curve. How can I get you to 85 years old with a minimal number of procedures, cumulative risk, and trauma?”  Benefits may vary, for some patients, the Medtronic TAVR procedure risks may outweigh the benefits. Please talk to your doctor to decide whether this therapy is right for you.

• Our patient community often asks about TAVR durability. Dr. Deeb said, “Valvular degeneration is quantified differently now.” He told us that when they only did surgical valves, they tracked patients until their valve deteriorated and needed a second surgery. “We called that durability,” Dr. Deeb said. “Now we’re following hemodynamics. (Hemodynamics and gradients are important to how your valve functions.) We follow the gradient and how hard the heart has to work when the valve begins to redevelop stenosis or a leak. Certain TAVR valves have better hemodynamics³ and less degeneration (dysfunction)⁴ than surgical valves.” (For more, see “Breaking News: New Medtronic Evolut Low-Risk TAVR Clinical Trial Results”.)

• Dr. Deeb said his best advice for patients considering a TAVR is to go to a multidisciplinary center of excellence and meet with the cardiologists and cardiac surgeons as a team. “They’re not advocating for surgery or TAVR. They’re advocating for what is best for you, what fits for you in that lifetime management,” he said.

The statements and information presented herein may be the opinion of the individual physician featured and is not intended to constitute medical advice.

Thanks Dr. Deeb and the University of Michigan Health!

Thank you to Dr. Deeb for answering our questions and sharing your experience and knowledge about TAVR to help our patient community make an informed and educated decision about aortic valve replacement! We also want to thank your team at the University Health in Ann Arbor, Michigan, for taking care of heart valve patients everywhere!

Related Links:

• Medtronic TAVR Procedure: What Should Patients Know?
• TAVR Heart Team Finder

Keep on tickin!
Adam

P.S. For the deaf and hard-of-hearing members of our community, I have provided a written transcript of this video below.

References:

¹ John D. Carroll, et. al, STS-ACC TVT Registry of Transcatheter Aortic Valve Replacement, Journal of the American College of Cardiology, Volume 76, Issue 21, 2020, Pages 2492-2516, ISSN 0735-1097.

² Adams DH, Popma JJ, Reardon MJ, et al. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med. May 8 2014;370(19):1790-8.

³ Forrest JK, Deeb GM, Yakubov SJ, et al. 4-Year Outcomes of Patients With Aortic Stenosis in the Evolut Low Risk Trial. J Am Coll Cardiol. Oct 18 2023.

⁴ Van Mieghem NM. Five-year bioprosthetic valve dysfunction after surgery or self-expanding TAVI. Presentation at EuroPCR. 2023.