Heart & Cardiology/TAVR

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Question
My 94 year old father has severe aortic stenosis, 0.5cm diameter. He is very short of breath and is in early heart failure. He really has no other medical problems. The cardiac doctors want him to have the TAVR procedure done, but he is terrified of having a stroke and cannot make up his mind. The alternative would be to go on hospice. In your opinion, how long would an aortic valve replacement by TAVR extend  his life in a quality way.? What is the real risk in doing TAVR in such an elderly man?  Some in our family want him to do this ,others don't and I feel very uncomfortable persuading him either way. Thank you for your time.

Answer
Hi,

I perform a lot of these TAVR procedures, and in my experience they have been one of the biggest game changers in cardiology. With severe symptomatic aortic stenosis the life expectancy is severely reduced. Traditionally many people considered to be high risk were not operated on as an option was not available however. TAVR has been proven vastly superior to medical management alone. The risk of stroke is in the region of a few %, however the risk of death without the procedure in symptomatic patients approaches 100% within a few yrs. Importantly the procedure will typically improve quality of life.

I would advise the following. Go to a high volume center where a heart team experienced in TAVR can perform a comprehensive evaluation of the risks and benefits and see whether your father is indeed a suitable candidate for the procedure. In our program and many others we even perform comprehensive neuropsychologic testing.Make sure the relevant members of the family are involved in the whole process. If they feel he is suitable, then the procedure may prolong his life, but more importantly the quality of it. If they don't then you have at least explored this option. TAVR valve follow up has gone reliable past 5 years, and past this the long term durability is unknown at this point but likely to extend well beyond that.

Hope that was helpful,  

Heart & Cardiology

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Mustafa Ahmed MD

Expertise

Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease

Experience

Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology

Organizations
http://blog.myheart.net

Publications
Multiple Publications In High Quality Peer Reviewed Journals. Internationally Recognized.

Education/Credentials
MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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