Two 90-year-old patients with aortic stenosis: TAVR vs. open heart surgery (8)

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Professor Dr. Tsuyoshi Kaneko MD, cardiac surgeon and expert in minimally invasive and transcatheter aortic valve and mitral valve replacement implantation, and aortic dissection treatment, and Dr. Anton Titov MD / Exclusive interview

- Is there a clinical case you could discuss, which illustrates some of the points that we discussed in our conversation today? Yes, so I really want to tell a case, and the message here is, what the future is going to be like in the field of cardiac surgery? So 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 aortic valve]. He was a very very healthy 90-year-old, very functional, he did very well after the operation, he spent about a week in the hospital, came back in about six weeks, he was still trying to recover, he had some fluid in the chest, so he receive a lot of Lasix [diuretic]. And 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. And this is 90-year-old, so he basically wasted six months in his remaining time. On the other hand, I recently treated another 90-year-old man, very healthy. But in this day and age we can treat [aortic stenosis] with TAVR. So this patient got TAVR. - TAVR is the minimally invasive Transcatheter Aortic Valve Replacement...

- That's right. We went through the groin [to put a catheter via femoral artery], no open chest surgery. We did this with no general anesthesia, he was awake during the whole time, and after the procedure he did well. He left the following day, on postoperative day #1. And we saw him about a month later, he was going to his yard, he was working on his garden, he was doing very well. And one year after [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. But you can see that the recovery is completely different. And for 90-year-olds that is something that really does not appear in the medical literature. [importance of faster recovery is not discussed] I think faster recovery, spending less time in the hospital, going back to what he liked before - I think that quality of life component is something that is really undervalued. It's very hard to measure, but it's undervalued. And I think there's going to be more and more of these minimally invasive procedures coming down the pipeline. There are multiple transcatheter devices for the mitral valve, there are transcatheter devices for the tricuspid valve, there are transcatheter devices for ascending aortic aneurisms that are currently being investigated. So I think with all these minimally invasive procedures coming down the pipeline, we will see a dramatic swing towards that direction in our field. And that is, fortunately or unfortunately for our field, the traditional open-heart surgery will diminish and we still have to know how to do them. But I think the traditional way of open-heart surgery will decrease. So we, our field - we have to be prepared. But at the same time that will provide better care for the patients and that's why we're here. So I think we're very excited to be in this field right now, and I'm very very excited for the patients in the future. These are very very interesting cases, they do indicate what the future brings. Yes, and I think we're heading towards there, I think five years ago nobody imagined that TAVR will be this big, and I think five years from now there are new devices that will be out there that we didn't imagine at this time. So I think times are moving very fast.
- Thank you very much, Dr. Kaneko! I hope to come back to you in the future, and hopefully we'll be able to talk more about the minimally invasive heart procedures as they pass along.
- Yes, thank you so much!

Two 90-year-old patients with aortic stenosis: TAVR vs. open heart surgery (8) top doctors washingtonian
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