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Question: I have been diagnosed with severe aortic stenosis in a heart valve. I am now having more symptoms, such as chest pains and shortness of breath. I’ve heard about a minimally-invasive procedure called TAVI. How does it compare to heart surgery to replace the valve.
Answer: The TAVI (Transcatheter Aortic Valve Implantation) procedure is currently being performed on only those patients who are not suitable for open-heart surgery. Of course, you could be one of those people. So it’s worthwhile exploring this option.
Let’s start with an explanation of the aortic valve, which is the source of your medical problem.
The aortic valve regulates the flow of oxygen-rich blood from the heart into the main blood vessel leading to the rest of the body. It is composed of three triangular-shaped flaps that fit neatly together.
As the main chamber of the heart contracts, the flaps open up and allow blood to enter into the artery. They then slap shut to prevent blood from flowing back into the heart. As with other parts of the body, over a long period of time this valve can wear out and become dysfunctional.
“Aortic-stenosis is, for the most part, a chronic degenerative process of aging.” says Dr. Sam Radhakrishnan, Director of the Cardiac Cath Labs and Physician Lead of the TAVI program at Sunnybrook Health Sciences Centre.
About 7 per cent of people over the age of 65 develop aortic stenosis.
Typically, the valve becomes caked in calcium deposits that narrow the opening and prevent it from operating properly. As a result, the heart has to work harder to pump blood around the body. Patients may experience chest pains, become quickly out of breath if they exert themselves and may suffer fainting spells as well as other symptoms. Eventually, they develop more serious complications including heart failure.
There is no medication that can reverse the damage.
“It requires a mechanical solution – the replacement of the valve,” explains Dr. Radhakrishnan.
This means patients have had to undergo open-heart surgery. The chest is cut open to expose the heart. The patient is placed on a heart-lung bypass machine while the heart is stopped. The surgeon cuts into the organ and removes the decrepit valve and then inserts a new one – either a mechanical device or one made partly with animal tissue.
This has been the standard treatment for several decades. But not all patients can withstand the rigors of open-heart surgery. They are too old and frail, or suffer from too many other health problems, to survive the operation. Roughly one-third of all patients with severe aortic stenosis are considered too high risk for open-heart surgery. Without treatment, their condition only gets worse. About 50 per cent of them die within one to two years without corrective therapies.
However, about 15 years ago doctors began to make significant progress on an alternative therapy known as Transcatheter Aortic Valve Implantation, or TAVI for short. (In the United States, it’s called Transcatheter Aortic Valve Replacement or TAVR.)
TAVI represents a Canadian-research success story. Much of the pioneering work was carried out by Dr. John Webb and his team at St. Paul’s Hospital in Vancouver.
Rather than cutting open the chest, TAVI accesses the heart through the circulatory system.
A catheter – a flexible hollow tube – containing a tightly-compacted replacement valve is inserted into an artery and carefully threaded to the heart. The most common route is through a leg artery, which can be accessed through a small incision in the groin.
Once the catheter is in the correct position – literally inside the old aortic valve – the new valve is released from the catheter and expands to its full size. The diseased flaps of the old valve are not removed, but flattened back and serve to anchor the new valve device in place. The new valve immediately takes over the job of regulating blood flow.
As an added bonus, the recovery time is much faster for TAVI patients who are typically out of hospital within three to five days. Open-heart surgery patients spend about 10 days in hospital and it takes a long time for their chest incision to heal.
TAVI is part of a growing trend in the field of minimally-invasive surgeries. For instance, stents – which prop-open clogged blood vessels – are also delivered to the right spot in the body by way of a catheter.
TAVI is not without risks, however. Threading the catheter – about the thickness of a pen – through the blood vessels can cause damage and dislodge plaque deposits. If pieces of that plaque travel to the brain they can block blood flow and trigger a stroke.
Furthermore, doctors don’t yet know how long the TAVI valves will last. “We don’t have definitive long-term – more than ten years – data for these patients yet,” says Dr. Radhakrishnan. By contrast, the durability of the valves used for the traditional open-heart surgery has been well documented.
Because TAVI is still relatively new and there are uncertainties surrounding the procedure, it should not be considered a patient’s first choice, says Dr. Radhakrishnan.
“If you’re deemed to be a good candidate for open-heart surgery, you should go for open-heart surgery. ”
So that mean TAVI is restricted to those patients who can’t tolerate the traditional approach or they are deemed to be at high risk of suffering serious complications from open-heart surgery.
TAVI patients must undergo a series of screening tests before being eligible for the procedure. High-resolution CT imaging machines are used to determine a number of important anatomical considerations to increase the chances for a successful TAVI procedure. For example, CT imaging helps to pick the best entry point for the catheter. If the leg artery poses a risk for complications, the doctors can use an artery under the collarbone or one in the chest wall.
This pre-operative investigation also enables the doctors to select the correct size of the replacement valve. (All of these valves are made of animal tissue, attached to a stainless-steel mesh.)
During the actual operation, high-resolution X-ray imaging is used to help guide the catheter through an artery to the exact spot in the heart where the new valve will be placed. A team of nurses and doctors from different disciplines– including an interventional cardiologist, cardiac surgeon and cardiac anesthetist – take part in the procedure.
Dr. Radhakrishnan believes TAVI will eventually be used in a broader range of patients.
“It is still an evolving technique and procedure,” he says. The equipment is changing, too. The catheters are becoming less bulky and newer valves are emerging made by different manufacturers.
“We are already seeing a lowering of the complications in terms of vascular complications, strokes and mortality,” says Dr. Radhakrishnan
“For the first generation devices, the incidence of stroke was close to 5 per cent in the first 30 days after the operation. Now we are seeing stroke rates of 2 to 3 per cent – which are very much in keeping with the stroke rates for traditional open-heart surgery.”
Sunnybrook, he notes, is involved in an international clinical trial that is evaluating a broader range of patients as potential TAVI candidates including those who are considered to be at intermediate risk of suffering complications from open-heart surgery.
And at a conference of the American College of Cardiology held in Washington, D.C. in April, a series of promising TAVI studies were made public.
“It is fair to say that as the technique gets better, some of the procedural risks will diminish and we will see it move into a larger population of patients,” predicts Dr. Radhakrishnan.
But, right now, one the biggest obstacle to its wider use is financial. “The TAVI procedure is more expensive than open-heart surgery because of the extra cost of these specialized valves,” explains Dr. Radhakrishnan. The TAVI valves cost around $20,000 apiece, while the open-heart valves are under $5,000.
In Ontario, the provincial government has provided six hospitals with funds allocated for the procedure. (In Toronto, the medical centres include Sunnybrook, St. Michael’s Hospital and the University Health Network.)
“We are funded to do 90 TAVI procedures in the coming year,” says Dr. Radhakrishnan, adding that the hospital has the capacity to do more but is limited by its budget.
He expects “market economies will undoubtedly bring down the cost of these devices” if research can show that TAVI really is a suitable option for many more patients.
Paul Taylor, Sunnybrook’s Patient Navigation Advisor, provides advice and answers questions from patients and their families, relying heavily on medical and health experts. His blog Personal Health Navigator is reprinted on Healthy Debate with the kind permission of Sunnybrook Health Sciences Centre. Email your questions to AskPaul@sunnybrook.ca and follow Paul on Twitter @epaultaylor
The comments section is closed.
TAVR is your best bet.
Go for it
God will look after you and provide the best medical team to look after you other than you loved ones. Believe in that. God loves people who trust Him
If I were you, I would have just thanked God. We all know that no magic can happen at this age. I am 74 and can compare my physical ablities as they are declining as an age factor.
My humble suggestion will be for you to be in positive mind as much as you can and keep thanking the Creator.
Wishing you all goodness in life. Enjoy the grand kids if you have, they will make you feel young and strong.
Regards
Muzaffar Iqbal
The surgery requires the surgeon to open the chest to access the heart. The most common type of open heart operation is a coronary artery bypass.
Yes I’m possibly looking into the near future of having aortic vavle replacement, but no way I’m having open heart surgery, when I can possibly have the minimal invasive surgery. I’m not that bad at all yet anyway.
Exceiient article.
I fainted (once) woke up and felt great but my daughter put me in tne
hospital. I took a lot of tests and had the Tavr operation, at 93 years of
age. Since I had a lot of confidence in my daughter (a M.D.) I never questioned
anything. My daughter who brought me to the hospital is a dentist and she
felt I was getting the right treatment. I feel good now but I don’t have the
run around energy I once had. Tavr test was on Oct. 2019, pace maker inserted days later Oct.2019. Today we are in Sept. 2020.
Do you have a comment?
I was 56 years old when I had a TAVI at the QEII in Halifax in September 2019. I liked that the hospital assigns cardiologists on a two-week rotation. They are your advocates. But all the cardiologists must agree on your treatment. Drs. Jackson and Cox were superb. The nurses and physiotherapists did everything to help me get back on track. Hospital food is never the greatest, but family, friends and ward mates all joined forces. We ate well, commiserated and laughed a lot. We helped each other with with whatever talents we had. This is a good thing; it’s a universal lesson. Yes, I can turn on your C-pap machine, but I can’t make it to the kitchen for a coffee. Yes, I can speak to you at length about your husband who passed last night, and I’m very grateful for the snack your daughter brought me this morning. I will speak with her too. She just lost her father. My parents are both dead. I understand. Let me stand by you.
After TAVI,my 88years old mother had an anaphylactic shock after administration of protamine sulfate . Went into 15 minutes cardiac arrest,resucitation,subsequent renal failure ,pulmonary edema and death after 3 months in the hospital.The TAVI was supposed to improve her quality of life.
Thank you so much for the information written regarding the TAVI heart valve. It is encouraging to know how medicine/science is progressing in this field. God Bless…..
Does Medicare pay for this procedure ? Who are skilled surgeons in this procedure in the Phila. Pa. and Camden County NJ area ?? How many patients die with this procedure at this point.
Quite useful info. I am researching for my 85 year old father. Is the cost covered by insurance for the TAVI valve? Dad is dealing w/ VA hospital here in Pittsburgh. Scheduled for cardiac cath next week. Looking for options. Thanks!
My 90 year old husband was out of the hospital in 24hours
Feeling great
No bleeding. I think this type of heart surgery is terrific
I
Of course he is not the usual 90 year old
Janet B
We used Colombia hospital In nyc
Doctor Nazif.
Fabulous man
C j mason. I had a tavi procedure, november 31st 2018 all going well
Only problem at moment is I I have high blood pressure which is
bding treated by my GP could you please tell me if this is a usual accuracy
after a tavi op. Thank you.
I’ve received the professional expertise of the Sunnybrook TAVI team. I was pre-screened and found to be a suitable candidate for the correcting procedure.
I suffered severe aortic stenosis. I am in my 86th year. I was operated on a Friday morning. No pain or complication post operative. I was back in my own residence Saturday evening. I return for a 6 month check up in February 2019.
Paul,
So glad procedure went well for you. My dad is a vet and using VA hosp. in Pittsburgh. 85years young; severe aortic stenosis. I thought TAVI could be option for him but they are dead set on doing cardiac cath as they “feel” it is more of a plumbing issue. They said they would have to go in through his chest and he is not a candidate for a 3rd open heart. How did they access your valve if I may ask? Thank you and God Bless!
Thank you for your clear explanation
My 82 yr old dad just had this done yesterday and feels amazing so far.
He is very happy and said he felt and feels no pain and he can get up and walk pretty good. I can see how I am going to have a hard time keeping up with him soon. This procedure is amazing. Thank Dr. Webb and his team at St. Paul’s Hospital, Vancouver B.C.
What is cost in India for the said surgery
None of the experts (cardiologists, surgeons …) I talked to after my aorta stenosis diagnosis has told me about the TAVI option; they all merely stated: you are a good candidate for open heart surgery.
After having read all the information on this site, I am confused, anxious …
I have no other major health problems, I “look good”, tanned, fit and healthy, but I am actually weak, always zonked out, have no energy, out of breath, dizzy – resting in bed 18 hours out of 24.
What should I do?
Maurice C.
I AM 90 YEARS OLD AND WONDER WHAT YOU THINK OF HAVING A TAVR? HOW RISKY DO YOU THINK IT MIGHT BE?
I ALSO HAVE A TUMOR ON MY LEFT KIDNEY. I HAVE NO PAIN ON TUMOR YET I AM NOT SURE I COULD HANDLE
THE REMOVAL OF TUMOR AND WHICH ONE SHOULD BE FIRST OR SHOULD JUST FORGET BOTH SURGERY?
THANK YOU FOR YOUR HONEST OPINION. THANK YOU
I am scheduled to have TARV in two weeks on the 14th of June. This came on so fast and it seems like I am being rushed to do this. At first it seemed like a simple surgery, but as I read about problems some people have had, I.m getting scared to have this surgery. I am 66, diabetic, had open heart by passes 20 years ago and in the last year, 4 stents. I do get tired more than I think is normal and sometimes weak, but I work everyday. I was not given the option for open heat surgery this time. I have had all the assessments and the TAVR team has met and cleared me for this surgery. My question is, could they have made a mistake in diagnosing me? What if I really didn’t need this???
I had a TAVI in December.last year at Leeds General. I am like you Diabetic on Insulin for the past 47 years, all went well. Went back a fortnight after the opp. No problems whatsoever. Before the TAVI I could walk 10 yards stop sit down then start again couldn’t climb stairs. Now I can walk round shopping centres AND climb stairs.
Best thing a Diabetic can have before the opp. I would have been dead by Christmas
You go for it.
my elderly father is scheduled for the TAVI procedure in September as he’s a very poor candidate for open heart surgery. From what all the doctors are telling me, he will feel 10 times better. So glad that this procedure has been developed for people who wouldn’t live through open heart surgery… Can’t wait to see him have enough energy to walk more than 15-20 feet at a time.
Hv sholrtness of breath….extensive fatigue…am 85. Should I hv TAVI…..scared to death of stroke…don’t know what to do..? Pray & adviseme pls..
What to take as an anti.flam as i am on warfarin after open heart surgery for aortic valve replacement. Also loose my breath often.What’s recovery period?
Excellent information provided in this article I just finished reading. I will be having Tavr procedure in the coming months. It is a little scary.
I hope that my mother Donna Lacey who was approved to have this can soon, she also has cancer so open heart would not be best for her, so I hope you can get my mother this surgery in the new year
Hi there
My nan has just had a TAVI op on Tuesday and has just been told she has severe aortic regurgitation (which she didn’t have before the op) and they are going to have to repeat the operation. We were not told a repeat operation was one of the risks and I cannot find any information online about patients having the TAVI twice, which is concerning…
Sue, my mum’s story may be helpful …
My mother aged 86 has just had this done in the UK (5 days ago) – discharged yesterday and already doing stuff around the house (hasn’t had this much energy for months) – very pleased with progress so far.
She had been getting increasingly short of breath over the last few months and had a nasty fall in the house 4 weeks ago so we were getting very worried.
My Mom is 89 yrs and has been getting more frail as time goes by. She has been recently Dx with Grade 4–severe aortic stenosis. What would the projected prognosis be if she were to have the procedure? Do you usually do this procedure on clients of this age. Her health is generally pretty good for her age, although she seems to be getting more short of breath and dizzy with minimal excertion. This is a new diagnosis for her and she is having difficulty dealing with it. We have had 2 cardiology consults and are presently waiting for the cardiac surgeon assessment. Would you share your thoughts with us.
Thank you
Sue M
I appreciate the details of information, now that I am schedule to undergo TAVI. Thanks again
Hi iam a 46 year old other wise very healthy cardiac patient, I was told that I couldn’t have surgery because my aortic valve spasms were now causing 100%stenosis in my valve ..but I’m feeling weaker everyday and my heart pill doesn’t seem to be working as well as it did before so I’m still having a lot of symptoms ..I saw this procedure on tv , how can I find out if it’s an real option for me ? Thank you
Amazing advances, a credit to our Hospitals dedication to research.
It is only a short time since the first heart transplant.
What a credit to our health system.
well written article
when was it composed and can you bring it up to date; today is the 24june 2016>
Hi Steve. My mum just out of hospital after TAVI procedure Mon. She sleeping, sweating & nauseous.
Any advice? Tx
Hi Steve: I am about to consent to TAVI aortic procedure in Calgary and feeling very unsure. I am 81 and in very good health otherwise and I am anxious to hear about someone’s experience after TAVI.
My 78 year old dad had this procedure done a year ago in Calgary and we are so thankful that this was an option for him. After two previous open heart surgeries, he was not a candidate for another one, to solve his valve problem. The TAVI procedure was a great success for my dad and improved his quality of life without question. Without this procedure he might not still be with us today and beyond. We were just back to see Dr Al Qoofi for a one year follow up and I just can not say enough good things about him and all of the wonderful team at the heart function clinics who have looked after my dad and kept him out of the hospital!
Hello Paul
Are there any hospitals in Vancouver or Victoria which can do minimally/non-invasive heart surgery on by-pass patients who are experiencing further problems with arteries blocking/angina/ “small” heart attack?
Thanks
My mom will have this procedure this week – Thursday. Health City, Cayman Islands. (Dr. Shetty’s) She is 75 years old and very frail. Please help me pray for her. :'(
very informative and helpful article to understand what TAVI is exactly. Thank you very much for your efforts towards humanity & health.
my mom has just had a tavi and it sems to all of us she is not well at all can not sit up for any length of time and walks with a frame now .she sufferd a mine stroke .wores now than she was before the tavi
Where did she get the TAVI and when. My mom is considering a TAVI and I am looking for information. My mom is 82,
Suzanne
Suzanne am considering this for my father in law. He is 82. Not sure if we should try. Your insights will help.
That scares me :(
So informative and helpful for one confronted with news this may his route to take. Thank You!
I wana know the success rate of TAVI along with CAD stenting.
hi, i have had a stroke which left me palisyed down one side about 14 years ago now that i am 59 years old will i be a candiate for minimaly invasive heart surgery.sorry for the spelling. thanks.
Hi Graham:
You will have to talk to a doctor to determine if you would be a candidate for this surgery. Talk to your family doctor first. And your family doctor should be able to tell you if you need a referral to a specialist.
Why are some cardiologist continue to push patients into doing the high risk procedure such as open heart surgery in read of the lower risk of a Tavi procedure. Most hospital blames it on funding while putting patients at higher risk of not survive the open heart procedure.
Thank you for this detailed explanation above. This information provided significant insight into this new procedure, as well as the rationale for my mothers Doctor NOT offering TAVI as the first treatment option to fix a severely diseased aortic valve!
My mother is 74 years old, has a hx of diabetes and renal failure and is on dialysis treatments. Eight weeks ago it was determined that the underlying reason for my mothers chest pains, shortness of breath and flash pulmonary edema was related to aortic and mitral valves stenosis, yet she was only given the option of open heart surgery though we’ve been told by THREE physicians including an internationally recognized cardiac surgeon that my mother has a very high risk of dying on the table, or will never leave hospital. However, despite this explanation, the community hospital will ONLY offer open heart surgery!
As a healthcare professional with knowledge of the risks for a person with significant comorbities as those mentioned, I was appalled that his was the only option given though my mother was never assessed for the suitability for TAVI! The craziness in all of this is that my mother has been in the hospital for nine weeks and counting but I now understand the reason for her not being given the option of TAVI and it’s strictly financial and simply unethical!
The stupidity of all this and which makes me angry is the physical burden on my mothers frail health over those many weeks, the emotional roller coaster for her family and the insane costs to tax payers for keeping my mother hospitalized and away from the comforts of home and family for all those weeks! I am fairly certain that the cost of hospitalization on a cardiac step down unit, frequent and additional dialysis treatments to keep my mother alive has exceeded the cost of one TAVI procedure and these costs continue to mount!
I have always supported the Canadian healthcare community as having high standards related to ethical care and I am really disappointed with my experience currently and have very little trust in our system. I can’t wait to get my mother out of the hospital as I am very tired of the doctors flip flopping with the information provided over the last eight weeks and have outright lied to us about the surgical risks and other information! This folks is our tax dollars in action and the healthcare system that we have to look to for care! I do hope that I have a quick and painless death as a way of avoiding hospitalization in this current system!
My husband is scheduled for by pass surgery Halifax. I have just learned that many hospitals Canadaoffer minimally ombasive surgery. He is 72, diabetic for 30 years, and had in 2008 had all tips broken on left side body. Would he be candidate for this procedure. And where?
My 77 year old mother has been give a choice of TAVI or open heart surgery as she has a severe aortic stenosis in a heart valve. The surgeon who would perform the TAVI was very enthusiastic about the procedure and said my mother was a good candidate. After some checking online I have found that a good candidate is someone in poor health or frail, of which my mother is neither, with no other illness at all in fact. Also the open heart surgeon who she just consulted has expressed his opinion that if she were his his mother, he would recommend open heart surgery, a tried and tested procedure and that the TAVI valve may not even last 10 years. My mother knows several other people who’ve had the OHS and have had no problems, no pain during or after the op and the valve has last 20 years and counting. I just wanted to share this on the internet as there is very little information out there where people have had to look into this choice and published their own conclusion. I would just reiterate the condition on my mother though – good health, late 70’s, so TAVI may still be your better option if you are high risk.
Hello. I am very interested in this, as I was once planning on becoming a doctor, until my own health problems became too much to continue my schooling. But I’ve always been interested in the human body and how it functions, and even more so when it malfunctions.
I’ve got a family member that is getting the TAVI soon. Her surgery was just postponed until September to wait until a smaller valve/newer technology is available to that hospital.
But my big question is about the history. You say that a lot of the research was done by Dr Webb at St Paul’s? I am very curious about that. The only history that I found in a very quick google search focused on France.
Thank you so much.
Your article was very helpful and informative.
Hi, I hear in the UK they are using another procedure called Key Hole surgery where they go in under the ribs – similar to gall batter incisions i believe. Drs can then exam the heart and fix what they find. recovery is very quick compared to opening up the chest. Is this available in Canada
TAVI (Transcatheter Aortic Valve Implantation) repairs the valve without removing the old, damaged valve. This is often performed to people with symptomatic aortic stenosis who are considered a high risk patient for standard valve replacement surgery. http://goo.gl/MbuA9o
My mother is 98 years old and suffering from aortic stenosis. She lives in the UK. Her cardiologist is unwilling to recommend either open heart surgery or TAVI saying the risks are too great.
Do you have data on success rates, survival rates, number of procedures (Canada+ USA) regarding the TAVI procedure? Can you share these data with me?
I appreciate your reply.
michaelrspender@gmail.com
There are currently studies underway to get a better understanding of how TAVI compares to open heart surgery.
The devices have evolved over time. So data collected from earlier trials may no longer be relevant today. The newer data, once it is available, should provide a clearer picture of the success and survival rates.
As with any procedure, the chances of success are partly determined by the underlying health of the patient. Patients in poor health tend to not do as well as those who are in better health.
Please keep in mind that TAVI is performed on only those patients who are not suitable for open-heart surgery. Furthermore, hospitals in Ontario are funded to provide only a certain number of these procedures per year. So there are limits on its availability.
How long and what us recommended for recovery of patient
I m 74 and I have had a tavr 1 week ago and I am doing so much better, I no longer suffer with walking or breathing, it is A GOD send. I pray they will be able to help your Mother as the surgery has made a difference in my daily life. God bless Paul C. Hassler email fuqueyatoo@gmail.com
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