TAVI vs. Open-Heart Surgery (SAVR) for Aortic Stenosis in Bangkok

• Aortic valve stenosis occurs when the aortic valve degenerates and cannot open or close properly, which can lead to serious complications. TAVI (Transcatheter aortic valve implantation) and open-heart surgery are two treatment options for this condition.
• TAVI is a minimally invasive procedure, typically recommended for elderly patients or those with existing health conditions. In contrast, open-heart surgery is generally more suitable for healthy, low-risk patients, allowing surgeons to directly assess and repair/replace the valve.
• Both procedures aim to treat heart valve disease and improve quality of life. Each has its own advantages and limitations, so consulting your cardiologist is essential to determine the most appropriate treatment plan.

Aortic valve stenosis is a type of heart valve disease caused by the degeneration of the aortic valve. When the valve becomes thickened or stiff, it cannot open and close properly, forcing the heart to work harder to pump blood to our body efficiently. Over time, this constant strain on the heart can lead to serious complications, such as heart failure or syncopy. Therefore, timely diagnosis and appropriate treatment are essential to improve quality of life and prevent further health risks.

TAVI (Transcatheter Aortic Valve Implantation), also known as TAVR (Transcatheter Aortic Valve Replacement), is a minimally invasive procedure used to treat aortic valve stenosis. During the procedure, a catheter is inserted through a small incision into a blood vessel to deliver a new valve that replaces the malfunctioning aortic valve.

Because TAVI is less invasive, it is typically suitable for:

• Older adults (age 75 and above)
• Patients with underlying health conditions that may increase the risks associated with open-heart surgery

TAVI has become one of the standard treatment options in both the United States and Europe. For many high-risk patients, it offers a safer alternative to traditional surgery. The procedure requires only a small incision, takes less time to perform, and allows for a faster recovery. With a success rate of up to 95%, TAVI stands out as an effective option for patients who are not candidates for open-heart surgery.

The newly implanted stent valve can last for up to a decade, provided no complications occur. Patients typically only need regular follow-up appointments with their cardiologist to monitor heart function and maintain their overall heart health.
 

Although TAVI has a generally high success rate, some patients may require a permanent pacemaker (PPM) after the procedure due to potential conduction disorders that can occur. Other complications are relatively rare and occur at a much lower rate.

Open-heart surgery, or Surgical Aortic Valve Replacement (SAVR), is the traditional method used to treat certain heart diseases. During this procedure, the surgeon makes an incision through the breastbone (sternum) to access the heart in order to repair or replace the damaged valve.

This approach remains a standard and effective treatment, typically recommended for patients who are in good overall health or considered low-risk for surgery.

Open-heart surgery is typically recommended for patients who are in good overall health and considered low-risk for surgery.

One key advantage of this approach is that cardiac surgeons can directly visualize and assess the heart, allowing them to identify and address any additional issues during the procedure.

Another notable difference between TAVI and open-heart surgery is the flexibility in valve selection. In open-heart surgery, patients may choose between a biological valve or a mechanical valve, each offering different benefits depending on the patient’s age, lifestyle, and medical condition.

Because it requires a larger incision than TAVI, open-heart surgery typically takes longer (often three hours or more) and involves a longer recovery period. The risk of complications can vary depending on the patient’s overall health and pre-existing medical conditions. Therefore, it is essential to discuss your individual health factors and treatment options thoroughly with your trusted healthcare provider.

*On average

Both procedures have their own advantages and limitations, but they share the same goal—to treat aortic valve disease and improve the patient’s quality of life. It’s important to remember that every patient’s journey is unique. The best way to determine which treatment is more suitable is to consult your trusted cardiologist, who can help plan the most appropriate care tailored to your individual needs.