Treatment options for severe Aortic Stenosis: Deciding between surgery and TAVI

Cardiology and Cardiothoracic Surgery

This leaflet will help you understand what aortic stenosis (AS) is, what treatment options are available and begin to explore which treatment option is best for you.

Together with your family you might want to think about:

• What your aim of treatment is

• What concerns you might have about the treatment options

• What questions you might have for the doctors

What is aortic stenosis?

Aortic stenosis is when the main valve, which allows blood to flow from the heart around the body, becomes narrowed. It generally gets worse over time and makes it harder for the heart to do its job. If left untreated it may shorten life expectancy.

Symptoms of severe aortic stenosis include:

• Breathlessness
• Feeling tired or not being able to do as much
• Chest pain
• Feeling dizzy or feeling like you might pass out
• Swelling of the legs

Most people with symptoms choose to have treatment to implant a new valve, which can relieve symptoms and make them live longer.

Some people may not be sure if their symptoms are caused by the narrowed valve or are worried about other health conditions. If this is the case we would encourage you to talk with your doctor about your options.

What are my treatment options?

There are two different options to treat your narrowed aortic valve, both treatments are successful with very good outcomes.

• Surgical aortic valve replacement (SAVR) which also includes minimally invasive aortic valve replacement (MIAVR)
• Transcatheter aortic valve implantation (TAVI)

SAVR is performed by surgeons whilst TAVI is undertaken by structural cardiologists. Both these teams will meet you when you come to the clinic and both of these treatments will be discussed with you in detail.

There is a lot to think about when trying to decide which treatment is the right one for you. The doctors and the team will try to provide you with enough information to help you reach your decision.

Both these choices are suitable for you and the decision is ultimately a personal one based on your health, values and your own preference.

SAVR – Surgical Aortic Valve Replacement

SAVR is open heart surgery where a new valve is placed in the heart directly.
It involves a cut along the breastbone to access the heart to replace the valve. SAVR is performed whilst asleep (general anaesthetic). The cut for MIAVR is smaller (5 to 6cm) along the upper part of the breastbone but otherwise is a similar procedure.

• Hospital stay: On average, 5 to 6 days
• Recovery time: 6 to 12 weeks
• Valve type: Mechanical or tissue valve is used depending on your circumstances.

TAVI – Transcatheter Aortic Valve Implantation

TAVI is a procedure where a new valve is placed in the heart through a small tube usually at the top of the leg. It involves numbing the area and making a small cut where the tube is inserted to access the heart and place the new valve. TAVI is usually performed while you are awake (local anaesthetic) with sedation if required.

• Hospital stay: On average, 1 day
• Recovery time: 2 to 3 days.
• Valve type: A tissue valve is used.

How long will my valve last?

Every patient is different, and we cannot see into the future to know how long your new valve will last. We know more about how long surgically replaced valves last than we do about TAVI valves as TAVI is a newer procedure.

A surgical tissue valve would be expected to last around 15 years. TAVI valves seem to function just as well as surgical tissue valves up to 8 years after implantation, but we do not have the research to comment beyond this yet.

While valve replacements usually last a long time, eventually your new valve may need to be replaced again. This can usually be done through surgery or TAVI depending on which method is best suited to you at the time. The timing of this is different for every patient.

In summary

SAVR – Surgical Aortic Valve Replacement

• Hospital stay and recovery is longer.
• The chance of having an irregular heart rhythm (atrial fibrillation) is higher, but is short lasting.
• The chance of bleeding and or needing a blood transfusion is higher.
• More is known about how long the valves last

TAVI – Transcatheter Aortic Valve Replacement

• The chance of a leak around the new valve is higher, but this rarely needs further treatment
• The chance of needing a permanent pacemaker is higher.
• A less invasive procedure with a shorter recovery time.

We understand that you might want to take some time to talk this over with your family or friends. If you have further questions then you can ask them at your appointment, please use the space on the next page to write down any questions you might have.

Alternatively, you can contact the team on the number at the end of this leaflet.

Questions

Where can I get more information?

Heart Valve Voice is the UK’s dedicated heart valve disease charity https://heartvalvevoice.com/

The South Tees NHS Foundation Trust website for:

• Surgical aortic valve replacement
  https://www.southtees.nhs.uk/services/cardiothoracic-services/cardiothoracic-surgery/
• Transcatheter aortic valve implantation
  https://www.southtees.nhs.uk/services/tavi/

Patient experience

South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.

This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.

To ensure we meet your communication needs please inform the Patient Experience Department of any special requirements, for example; braille or large print.

T: 01642 835964
E: [email protected]

The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW.
Telephone: 01642 850850

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