TAVR vs. Open Heart Surgery for Aortic Stenosis in Elderly Patients

Jump To Section

• TAVR vs. Surgery Recovery Comparison
• Clinical Case: Open Heart Surgery
• Clinical Case: TAVR Procedure
• Quality of Life Benefits of TAVR
• Future of Minimally Invasive Cardiac Surgery
• Rapid Advancements in Technology

TAVR vs. Surgery Recovery Comparison

Dr. Tsuyoshi Kaneko, MD, presents a powerful clinical comparison of two 90-year-old patients with severe aortic stenosis. This case study illustrates the profound evolution in treatment options, contrasting the lengthy and difficult recovery from traditional open-heart surgery with the rapid recovery enabled by Transcatheter Aortic Valve Replacement (TAVR). The difference in postoperative experience for these two similarly healthy nonagenarians underscores a major shift in cardiac care paradigms.

Clinical Case: Open Heart Surgery

Dr. Tsuyoshi Kaneko, MD, describes the first patient who underwent surgical aortic valve replacement approximately a decade ago. Despite being very healthy and functional for his age, the patient's recovery was protracted and challenging. He spent a week in the hospital but was readmitted six weeks later with complications like pleural effusion, requiring aggressive diuretic therapy with Lasix.

Dr. Tsuyoshi Kaneko, MD, emphasizes that while the patient eventually recovered, the process took over six months for him to fully regain his strength. This lengthy convalescence meant the patient effectively lost half a year of his remaining life to recovery, a significant quality of life consideration that is often undervalued in clinical studies.

Clinical Case: TAVR Procedure

The second 90-year-old patient was treated recently with the minimally invasive TAVR procedure. Dr. Tsuyoshi Kaneko, MD, explains that TAVR was performed percutaneously through the femoral artery in the groin, eliminating the need to open the chest. Crucially, the procedure was done without general anesthesia, meaning the patient was awake throughout the entire valve replacement.

The recovery was remarkably fast. Dr. Tsuyoshi Kaneko, MD, notes the patient was discharged on postoperative day one. At a one-month follow-up in the outpatient clinic, the patient was already active in his garden. Most impressively, one year after the TAVR heart procedure, the patient was reported to be feeling better than ever, a stark contrast to the six-month recovery of the surgical patient.

Quality of Life Benefits of TAVR

Dr. Tsuyoshi Kaneko, MD, makes a critical point that while TAVR may not be universally superior to surgery in all respects, the recovery experience is "completely different." The dramatic reduction in hospital stay and the rapid return to normal activities and hobbies represent a massive quality of life benefit for elderly patients. This faster recovery time is a factor that Dr. Kaneko believes is not sufficiently discussed in the medical literature or captured in traditional outcomes measurements.

During his interview with Dr. Anton Titov, MD, Dr. Kaneko stressed that this preservation of a patient's valuable time and independence is a paramount consideration, especially for nonagenarians for whom time is precious.

Future of Minimally Invasive Cardiac Surgery

Dr. Tsuyoshi Kaneko, MD, sees these two cases as a microcosm of the future of cardiac surgery. He predicts a dramatic shift away from traditional open-heart surgery toward a wide array of transcatheter, minimally invasive procedures. This innovation is expanding beyond the aortic valve to include transcatheter devices for treating mitral valve disease, tricuspid valve disease, and even ascending aortic aneurysms, all of which are currently under investigation.

Dr. Kaneko tells Dr. Anton Titov, MD, that while the knowledge of how to perform open-heart surgery must be preserved, its prevalence will undoubtedly diminish. This evolution, he asserts, is ultimately for the better, as it "will provide better care for the patients," which is the ultimate goal of the field.

Rapid Advancements in Technology

The pace of change in cardiac surgery is accelerating at an unprecedented rate. Dr. Tsuyoshi Kaneko, MD, reflects that just five years ago, the current level of success with TAVR was unimaginable. He expresses great excitement for both cardiac surgeons and future heart disease patients, confidently predicting that the next five years will bring forth new devices and procedures that we cannot even conceive of today.

This sentiment, shared in his conversation with Dr. Anton Titov, MD, highlights a transformative era in medicine where minimally invasive techniques are rapidly improving patient outcomes and redefining standards of care for structural heart disease.

Full Transcript

Dr. Anton Titov, MD: Aortic valve replacement by TAVI/TAVR in the very elderly patient. A clinical situation example. Is there a clinical case you could discuss? Please discuss a medical situation that illustrates some of the points that we discussed in our conversation today.

Dr. Tsuyoshi Kaneko, MD: Yes, so I really want to tell a case. The message here is about how the future is going to be in the field of cardiac surgery.

Dr. Tsuyoshi Kaneko, MD: I had two similar 90-year-old patients. The first 90-year-old patient, who was treated about ten years ago, received open-heart surgery to replace the aortic valve. He was a very, very healthy 90-year-old. He was very functional. He did very well after the operation. He spent about a week in the hospital.

He was then admitted back to the hospital in about six weeks. He was still trying to recover; he had some fluid in the chest. We injected a lot of Lasix, a diuretic. Eventually, he recovered, but it took him over six months. It took about six to eight months for him to completely regain strength and feel better.

This is a 90-year-old patient. So he basically wasted six months of his remaining time.

On the other hand, I recently treated another 90-year-old man. He was very healthy. But today we can treat aortic stenosis with TAVR.

Dr. Tsuyoshi Kaneko, MD: This very old patient got TAVR. TAVR is the minimally invasive Transcatheter Aortic Valve Replacement. That's correct. We went through the groin to put a catheter via the femoral artery. There was no need for open chest surgery. We did this without general anesthesia. The patient was awake during the whole time of TAVR.

After the TAVI procedure, he did well. He left the following day, on postoperative day one.

Dr. Tsuyoshi Kaneko, MD: We saw him about a month later in the outpatient clinic. He was going to his yard, he was working on his garden, he was doing very well. One year after the minimally invasive TAVR heart procedure, he is feeling better than ever.

I'm not saying that TAVR is completely better than surgical aortic valve replacement.

Dr. Anton Titov, MD: But you can see that the recovery is completely different. For a 90-year-old patient, fast recovery time after the procedure is something that really does not appear in the medical literature. The importance of faster recovery is not discussed. I think that faster recovery after TAVR is very important.

Dr. Anton Titov, MD: Patients are spending less time in the hospital, going back to what they liked before. I think that quality of life component is something that is really undervalued in TAVI/TAVR. It's very hard to measure, but it's undervalued.

Dr. Tsuyoshi Kaneko, MD: I think there is going to be more and more of these minimally invasive procedures in the future. There are multiple transcatheter devices for the mitral valve. There are transcatheter devices for the tricuspid valve. There are transcatheter devices for ascending aortic aneurysms. All those are currently being investigated.

I think all these minimally invasive procedures are being developed. We will soon see a dramatic change towards minimally invasive cardiac surgery.

Dr. Anton Titov, MD: That is, fortunately or unfortunately, the traditional open-heart surgery will diminish. We still have to know how to do open heart surgery.

Dr. Tsuyoshi Kaneko, MD: But I think the traditional method of open-heart surgery will decrease. We have to be prepared. But at the same time, that will provide better care for the patients. That is why we are here.

I think we are very excited to be in the cardiac surgery field now. I'm very, very excited for the heart disease patients in the future.

Dr. Anton Titov, MD: These are very, very interesting cases; they do indicate what the future brings. Yes, and I think we are heading towards there.

Dr. Tsuyoshi Kaneko, MD: I think five years ago nobody imagined that TAVR would be so successful. I think five years from now there will be new devices that we didn't imagine at this time. I think times in heart surgery are moving very fast.

Dr. Anton Titov, MD: Thank you very much, Dr. Kaneko! I hope to come back to you in the future. Hopefully, we will be able to talk more about the minimally invasive heart procedures.

Dr. Tsuyoshi Kaneko, MD: Yes, thank you so much!