What is aortic valve replacement surgery?

Steven J. Kernis, MD 

The term surgery is not quite as easily defined today as it was many years ago. By definition, surgery implies a procedure involving an incision, so the traditional surgery for valve replacement was called sternotomy, which is similar to bypass or open-heart surgery and is obviously risky and has a long recovery. During a sternotomy, the surgeon opens up the heart, removes the old valve and sews in a new valve. With the advent of the transcatheter aortic valve replacement (TAVR) technology, you can get a new valve without requiring any incision at all. The TAVR valve is delivered inside a stent, where it is collapsed like an umbrella. The physician pushes the stent through a catheter, which is like a long straw, and it travels into one of the arteries and into the heart. Once inside the heart, the stent opens up, again, like an umbrella, and compresses the old valve against the wall of the heart. The new valve works immediately.

A person with an aortic valve that is severely diseased or dysfunctional, meaning the valves can fail, is a candidate for aortic valve replacement. In fact, the basis of consideration of getting a valve replacement is determined on if the valve is severely dysfunctional and doesn’t open and/or close properly. Valves function like a doorway, and all the aortic valve does is open up and close so that the blood goes in where it should and in the direction that it should. The aortic valve is the last doorway before the blood leaves the left side of the heart. It’s sort of a big, main pumping chamber for the entire body other than the lungs. If the valve isn’t opening correctly, you can imagine what a problem that would cause for people. If the valve doesn’t close normally, then when the blood gets ejected out of the heart, a lot of it can regurgitate or leak backwards. Another thing to consider during valve replacement is whether the dysfunctional valve is causing somebody symptoms or a problem that disrupt everyday activities, such as not feeling well or difficulty breathing. The other thing that can happen is the body can fill up with fluid, causing heart failure. 



How does TAVR differ from traditional aortic valve replacement surgery?

Steven J. Kernis, MD 

Transcatheter aortic valve replacement (TAVR) differs from traditional surgical aortic valve replacement in that TAVR does not require opening up the chest and heart, or general anesthesia.

The standard surgical aortic valve replacement, which has been around for a long time, involves traditional or conventional sternotomy — opening up the breast bone. The person is under general anesthesia on a bypass machine. The heart is stopped and cooled down. The surgeons open up the chest and the heart to get to the old valve where they can see it. They actually cut it out and then take either a tissue or mechanical valve and sew it into place in the heart. The surgeons have other surgical options that don’t necessarily require opening up the breast bone, but in any way that they do it, it involves some type of chest incision, going on a bypass machine, stopping the heart and all of the risks that go along with that.

Transcatheter aortic valve replacement (TAVR) on the other hand allows surgeons to give someone a new heart valve through the groin, with no incision.  Most people do not require general anesthesia, just simple sedation, and they are up walking around later in the day with nothing but a little needle stick in the groin. This can be mildly uncomfortable, but certainly nothing like opening up the breast bone.


This content originally appeared on Sharecare.com.