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Keyhole vs open heart surgery: gamechanging trial on aortic stenosis

Aortic stenosis is a condition in which the valve between the main pumping chamber of the heart (left ventricle) and the main artery to the body (aorta) becomes thickened with reduced mobility. This results in reduced blood flow leading to chest pain, heart failure, blackouts (syncope) or death.

Treatment of severe aortic stenosis requires replacement of the valve. This may occur with a minimally invasive procedure called TAVI (transcatheter aortic valve insertion) or with open heart aortic valve surgery.
TAVI is a novel way of treating severe aortic stenosis. The replacement valve can be inserted in a minimally invasive manner avoiding the need for open heart surgery. The most common access sites for this procedure are through the artery at the top of the leg (femoral artery) or via the artery at the top of the shoulder (subclavian artery). The procedure can be performed with the patient awake and discharge from hospital can occur within 3 days.

Until now TAVI has been used to treat those patients with severe aortic stenosis who are unlikely to survive open heart surgery. A major trial, published in the prestigious New England Journal of Medicine, has reported this week and has demonstrated that TAVI is in fact better than conventional open-heart surgery even in patients who are considered suitable for open heart surgery (low surgical risk). These patients with severe aortic stenosis (and low surgical risk) were offered TAVI or surgery. Those undergoing TAVI had significantly lower rates of death, stroke and repeat hospitalisation.

Our very own Dr Sayan Sen at One Heart Clinic who performs TAVI and is at the forefront of international cardiovascular research echoed the comments of other senior cardiologists around the world that ‘this will change the way we treat patients with severe aortic stenosis. With better outcomes it is only a matter of time before TAVI is the standard of treatment for aortic stenosis’.