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    TAVI vs SAVR: What’s more Effective?

    What is TAVI?

    TAVI also called TAVR, is a minimally invasive procedure in which a new valve is inserted without removing the damaged valve. This procedure helps to improve a damaged aortic valve. During this procedure, an artificial valve is implanted into a heart. It has been introduced in 2002 and since that, it has gained immense popularity and transformed the treatment facilities available to different-risk group patients with severe symptomatic AS.

    TAVI can be performed through quite small openings without disturbing the anatomy of the chest wall. A patient’s experience with TAVI can be compared with the experience of a coronary angiogram in terms of recovery and it may be similar.

    There are two recognized approaches for TAVI. One of them is entering through the femoral artery, called the transfemoral approach. This does not carry a surgical incision in the chest. The other one is using a minimally invasive approach with a small incision in the chest and getting access into the chest through a large artery in the chest or through the tip of the left ventricle. This is known as the transapical approach1.

    What is SAVR

    It is an open-heart surgical procedure that has been done on thousands of people with aortic stenosis in varying degrees. However, in the modern era, the majority of SAVR procedures are done on low-risk patients. The mortality of SAVR during an operation varies widely according to a patient’s condition.

    During a SAVR procedure, an incision is required to get access to the heart. Then the diseased aortic valve is removed and replaced with a new valve. For many years, SAVR had been the standard treatment of choice for severe aortic stenosis patients until the arrival of TAVI.

    What is more effective?

    There are lots of discussions, and studies going on at the moment debating what is more effective than the other. But when we consider studies like the randomized SURTAVI trial which concluded that Aortic valve replacement, either by surgical or transcatheter approach, appears similarly effective and safe for males and females at intermediate surgical risk. Functional status appears to improve most in females after TAVI.

    You will likely spend less time in the hospital after TAVI compared to SAVR. This means the patient has more time to be in his comfortable environment rather than staying in a stressful hospital environment.

    Another recent study has suggested that TAVI is available to patients in all risk categories. For people who have limited choices for the repair of their aortic valve, TAVI is an effective option in terms of improving their quality of life. With the majority of SAVR procedures being done on low-risk patients, recent results from the PARTNER and Evolut Low-Risk trials have raised the question of TAVI use in the patient category as well as an alternative to SAVR.

    Long-Term Valve Performance of TAVI and SAVR-PARTNER I trial demonstrates that valve performance and cardiac hemodynamics are stable after implantation in both SAPIEN TAVI and SAVR in patients alive at 5 years.

    Conclusion


    Even though TAVI has the upper hand as it is a minimally invasive procedure and a patient is more comfortable after the surgery, there is still a place for SAVR in low-risk category patients. However, TAVI is being rapidly developed and in near future, it is predicted that TAVI will be used more widely than now successfully replacing SAVR even for low-risk category patients.

    Sources

    1. What is TAVR? (TAVI) | American Heart Association. Accessed June 24, 2022. https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/understanding-your-heart-valve-treatment-options/what-is-tavr
    2. Van Mieghem NM, Reardon MJ, Yakubov SJ, et al. Clinical outcomes of TAVI or SAVR in men and women with aortic stenosis at intermediate operative risk: a post hoc analysis of the randomised SURTAVI trial. EuroIntervention. 2020;16(10):833-841. doi:10.4244/EIJ-D-20-00303
    3.  Khalil KN, Forcillo J. SAVR contemporary outcomes in TAVI era: Still a valid option for the future. J Card Surg. 2021;36(4):1477-1478. doi:10.1111/JOCS.15439

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