Comparison of patient outcome for aortic valve replacement verses transcatheter aortic valve replacement
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Aortic stenosis or narrowing of the aortic valve is the most common cause for surgical valvular replacement in the United States. The disease of aortic stenosis has a long asymptomatic latency period followed by a quickly progressing symptomatic phase. Symptoms of the disease include dyspnea, syncope, angina, and heart failure. The disease affects mostly the elderly and, as the United States population ages, and life expectancy increases, there is an increased prevalence of the disease. The main cause of aortic stenosis is calcification of the leaflets of the aortic valve. There are currently no pharmaceutical interventions to combat or slow the processes of the disease. The only treatment for the disease is the surgical replacement of the aortic valve. The original aortic valve replacement (AVR) was done in 1952, after that time this was the only surgical intervention until 2002 with the advent of transcatheter aortic valve replacement (TAVR). TAVR has since been approved by the Food and Drug Administration (FDA) for use in patients who are not candidates for AVR or who are at high risk for AVR. The initial studies of TAVR showed an elevated risk of stroke in those undergoing surgery but it provided similar relief of symptoms, and similar patient mortality at one and two year follow up. With the increased risk of stroke there was evaluation of cause and mechanism of the cerebral events. After concluding that the strokes were due to emboli released during mechanical movement during surgery, new technologies have begun to be developed to combat the stroke risk. One device that is used is a deflection device that ensures that an embolus does not have access to cerebral circulation. Through the study of current literature it can be concluded that the patient long-term outcomes are much improved in TAVR verse AVR for the subgroup of the population who are not candidates for surgery. There are comparable patient outcomes for those who are at a high risk for surgery, but the risk for stroke with TAVR doubled compared to AVR, which continues to be investigated. TAVR carries the benefit of a less invasive surgery, shorter hospital stays and reported increased quality of life one-year post operation. This study demonstrates that there is still a need for further development of technology, surgical technique and long term patient follow up to ensure high quality outcome for those undergoing TAVR.