As heart valve replacement technology has evolved, patients facing aortic stenosis—an often life-threatening narrowing of the aortic valve—now have more options. Two common treatments are Transcatheter Aortic Valve Implantation (TAVI) and traditional open-heart surgery. Understanding the differences between these approaches can help patients make informed decisions in consultation with their treating cardiologist.
What is TAVI?
TAVI is a minimally invasive heart procedure that replaces a damaged aortic valve without the need for open-heart surgery. It is also sometimes referred to as Transcatheter aortic valve replacement (TAVR). The new heart valve is inserted via catheter through an incision in the groin, guided inside the affected valve, and expanded to reopen it. In a TAVR procedure, a doctor can repair a diseased aortic valve without open heart surgery.
This method is generally preferred for patients at high risk for open-heart surgery, though advancements have expanded its use to those at intermediate or even low surgical risk.
What is Open-Heart Surgery?
In contrast, traditional open-heart surgery, also known as coronary artery bypass (CABG) involves a more invasive process. The surgeon makes an incision in the chest, halts the heart, and uses a heart-lung machine to maintain circulation. The damaged valve is completely removed and replaced. Though this method has been the gold standard for over 50 years, it requires a longer recovery time. Patients usually spend a week in the hospital.
How long is recovery from TAVI and Coronary Bypass?
One of the main differences between TAVI and open-heart surgery is recovery time. Patients undergoing TAVI typically have shorter hospital stays, with many able to return home within a day or two. Open-heart surgery, however, involves a longer recovery period due to the invasive nature of the procedure.
We can carry out the TAVI procedure under conscious sedation, rather than general anesthesia, and the patient is able to go home the next day.
How long does a TAVI valve last?
In terms of durability, the valves used in open-heart surgery are known to last longer, which is why this method is still preferred for younger patients. TAVI valves, while less durable, have improved significantly with technological advancements and may still be the best option for older patients who are less able to withstand the rigors of surgery.
According to the British Heart Foundation, more research is needed to determine the long-term durability of TAVI valves. However, current studies show that for most patients, the valves remain in good condition six years after the procedure. As techniques and technologies continue to advance, the longevity of TAVI valves is expected to improve even further.
Who is a suitable candidate for TAVI?
TAVI was originally reserved for patients who were considered too high-risk for open-heart surgery due to age or health conditions. Today, however, even patients at lower risk can be considered for the procedure if specific circumstances favour the approach, for example anatomical challenges, such as a heavily calcified or narrow aortic valve.
The TAVI procedure is particularly well-suited for elderly patients or those with conditions like frailty or past heart surgery. Open-heart surgery, meanwhile, is still recommended for younger patients and those with congenital valve abnormalities.
Dr. D. Sean Stewart, an interventional cardiologist, notes that “TAVI is now an option even for patients for whom open heart surgery would be low risk,” expanding its use to a broader range of candidates.
Finally, both TAVI and open-heart surgery are effective treatments for aortic valve stenosis, but the choice depends on individual patient factors such as age, overall health, and risk tolerance. A thorough discussion with a cardiologist is crucial to determining the best approach for you.
Cost of TAVR vs Open Heart Surgery
The cost of TAVI/TAVR and open heart surgery can vary significantly depending on the country and healthcare provider.
The cost of open heart surgery and surgical aortic valve replacement is between £35,000 and £40,000 in London for private paying patients.
The cost of TAVI in London typically ranges from £60,000 to £70,000. This higher price is largely due to the significant research and development expenses involved in producing the TAVI valves. These costs contribute to the overall price, making it more expensive compared to other countries.
The cost of TAVI in Turkey is typically around €30,000 to €35,000 EUR, positioning it as a more affordable option for patients seeking alternatives to the UK and USA.
Where to find the best Interventional Cardiologists performing TAVI
If you are considering TAVI, it is essential to choose a hospital known for its expertise in interventional cardiology and heart valve replacement procedures. The USA leads the global market when it comes to top ranked academic heart institutions and here are some of the top heart hospitals in the USA that are renowned for performing TAVI procedures:
- Cleveland Clinic (Cleveland, Ohio) – The Cleveland Clinic is globally recognized for its cardiology department and has been ranked as the #1 hospital for cardiology and heart surgery in the USA for many years.
- Mayo Clinic (Rochester, Minnesota) – Mayo Clinic is known for its advanced heart care, including TAVI, with a strong emphasis on minimally invasive procedures and excellent patient outcomes.
- Cedars-Sinai Medical Center (Los Angeles, California) – Cedars-Sinai’s Smidt Heart Institute has a team of world-leading experts in TAVI and consistently ranks among the top hospitals in the USA for heart care.
- NewYork-Presbyterian Hospital/Columbia University Medical Center (New York) – This institution is at the forefront of heart valve treatments, including TAVI, and is home to some of the top cardiologists in the field.
- Mount Sinai Hospital (New York) – Mount Sinai’s Heart Center is renowned for its expertise in treating complex heart conditions with minimally invasive techniques like TAVI.
These hospitals have internationally reputable heart centers and experienced interventional cardiologists who specialize in treating aortic stenosis with TAVI. When choosing a heart center, it’s important to discuss your condition with a cardiologist to determine the best course of treatment.
If you are considering cardiac treatment overseas, please get in touch to be connected to the best cardiologists around the world. We offer medical travel assistance worldwide across the best hospitals in the UK, USA, Europe and Asia.
