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Jul 19, 2011

Minimally Invasive Procedure for Replacing Surgical Aortic Valves

TAV-in-SAV procedure safe and effective in high-risk patients.

Aortic stenosis occurs when the main artery carrying blood out of the heart, known as the aorta, fails to open fully. This condition reduces blood flow from the heart, often causing fatigue and shortness of breath, and greatly increasing risk for heart failure. Surgery can correct aortic stenosis in most patients by replacing the faulty aortic valve with a prosthetic valve, often through open heart surgery. Although a less invasive procedure exists, known as TAVI (transcatheter aortic valve implantation), this method is often reserved for high-risk patients, as it is a relatively new procedure and is associated with certain health risks. However, TAVI may also be used for another purpose — to replace failing aortic valves implanted during open heart surgery.

Although surgical aortic bioprosthetic valves have proven extremely successful in treating aortic stenosis, they can wear out over time, particularly in patients receiving the valve at a younger age (50–60 vs. 60 and greater). Surgical valves can also malfunction or cause infections in some patients, requiring a redo aortic valve surgery. The problem is that most patients needing redo surgeries are older with more health conditions, making open heart surgery extremely risky. To address this issue, researchers have investigated the use of TAVI to replace surgical aortic valves during redo surgeries. TAVI is a procedure that sends a valve to the heart through a small tube, known as a catheter, to replace the failing surgical valve.

Although using TAVI to replace surgical aortic valves is not often performed, a recent study published in the Journal of the American College of Cardiology: Cardiovascular Interventions found that it can be a safe and effective option for high-risk patients. Out of 20 high-risk patients involved in this study, TAVI was successful in correcting 18 of the patients’ failing surgical aortic valves. While this procedure, known as TAV-in-SAV, requires additional research before being widely implemented, the findings are encouraging. For high-risk patients, TAV-in-SAV may provide an option that can not only save their lives but also greatly improve quality of life.

Read this Article in the Journal of the American College of Cardiology.

Questions for You to Consider

  • Why is TAV-in-SAV used primarily for high-risk patients only?

  • Redo aortic valve surgery is the safest option for most patients with failing surgical aortic valves, associated with only a 2–7% risk of operative mortality. However, for patients that are high-risk, redo aortic valve surgery is much more dangerous, increasing risk of mortality to more than 30%. Therefore, TAVI may be a better and safer option for high-risk patients.
  • How often do patients with surgical aortic valves require redo surgery?

  • Risk of reoperation decreases with the age at which the surgical valve was implanted. For example, nearly half of those receiving a surgical valve at age 50 may require replacement valves later in life, while less than 10% of those receiving valve implantation at age 75 will require reoperation.


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Heart Disease and Aortic Stenosis Remain a Challenging Combination

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