Weighing the Clinical Risks
Choosing between TAVR and redo SAVR ultimately comes down to weighing the procedures’ various risks and benefits, many of which shift depending on factors like your age, health, and how long you’ll need the replacement valve.
Survival Rates
Research comparing these two procedures is limited, making it challenging to draw concrete conclusions or collect survival statistics.
But the studies that have been done suggest survival rates for valve-in-valve TAVR are better than redo SAVR in the short term, but this reverses in the long-term. The actual reversal point varies across the research, but may be in the one- to two-year range.
But one major caveat exists: The patient groups in these studies are not often equal in terms of their overall health because heart teams are much more likely to recommend that patients who are older, sicker, and frailer get the less-invasive TAVR over SAVR.
Patients who undergo redo SAVR are typically the lower-risk patients who don’t have any prior open-heart surgery or other major illnesses, Dr. Eleid says.
Complication Risks
There are some notable similarities and differences between TAVR and SAVR when it comes to risk of complications.
Recovery
One of the biggest benefits of TAVR over SAVR is recovery time.
“For [open] surgery, the first 24 hours are typically in the intensive care unit, depending on how complex the surgery is,” Tang says. “For TAVR, most patients, unless there’s a complication, go straight to the regularly monitored floor and get discharged once they’re medically ready.”
This also means that people who undergo TAVR are able to get up and move around a lot sooner. They usually have to rest in bed for several hours to allow the artery in the leg to heal, Eleid says. “Patients are usually walking in the afternoon or evening that same day,” he notes.
You will be able to go home within a day or two after TAVR and can get back to your normal activities after a week. SAVR requires about a week recovering in the hospital, plus another 4 to 12 recovery weeks at home.
Pacemakers
Both TAVR and SAVR carry risks for needing a permanent pacemaker implantation.
“When we’re fixing the aortic valve with any technique, we can injure the wiring of the heart because the conduction system, the electrical system of our heart, runs right by the aortic valve,” Eleid says.
Some studies suggest redo SAVR carries a greater risk of pacemaker implantation than valve-in-valve TAVR. Researchers speculate that the retained prosthetic frame in a valve-in-valve procedure may actually protect the heart’s conduction system during the procedure.
Valve Longevity
It’s important to consider how long your replacement valve will last, especially if you’re a younger patient who may have it for years to come.
“Surgical valves last quite some time, especially the current generation, which tends to last 10 or more years,” Tang says. “For TAVR, we now have up to 7-year data that looks very good … but beyond that we’re not sure yet.”
Generally, bioprosthetic valves made from pig or cow tissue are not as durable for younger patients, whether implanted with SAVR or TAVR. “The reason is that the metabolism is different and the immune response to the tissue valve is different for younger patients,” Tang says. Mechanical valves are another option but they require lifelong anticoagulant medications.
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