Aortic Valve Surgery in High Risk Patients

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Submitted by Dr T on April 4, 2014 – 6:50pm

Question: 
TAVR vs. SAVR.
My 85 mother has severe AS.  Went to one hospital where tey have done 140 TAVR’s andthey said she is a high risk patient and they would do theTAVR.  Hospital has a good reputation. 
Went to oneof the top 5 cardiachospitals in he country, tey have doneover 1000 TAVRs.  They said herSTS is 4% and they couldputher in a Partner 2 trial where she hs a 50/50 chance of TAVR.
I don’t know what to do
Thanks

If your mother is not a candidate for a standard aortic valve replacement, a Transcatheter Aortic Valve Implantation (TAVI) may be an option. Patients in this category have no chance of long term survival. I discussed this before. Read more here: 

However, if her STS operative risk was calculated @ 4% she is NOT high risk (i.e. inoperable) and should be considered for a standard aortic valve repair or replacement.

I would first recommend a consultation with a cardiac surgeon rather than just her cardiologist. As a (now retired) cardiac surgeon I have done many aortic valve replacements in patients just like her (and with excellent results), a much superior operation if it can be done! TAVI was designed for patients who are considered inoperable otherwise, unlike your mother.

The PARTNER 2 trial was designed to test one valve (the Edwards SAPIEN valve), is sponsored by this company and tests this valve against a standard valve replacement. If enrolled, it will be a 50-50 chance of one procedure against the other. Participating hospitals are among the best in the country, but trials like this eliminate the chance of making an individual decision – in this case making an optimal choice (I believe a aortic valve replacement) rather than a throw of the dice.

If her risk had been calculated much higher, this trial might be an option.

Hope this helps,

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