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ProceduresJanuary 2025• 6 min read

TAVR vs. Open Heart Surgery: Which is Right for You?

A comprehensive comparison to help you understand your options for aortic valve replacement.

If you've been diagnosed with severe aortic stenosis, your doctor has likely mentioned that you need your aortic valve replaced. Until recently, this meant open heart surgery. But today, there's another option: TAVR (Transcatheter Aortic Valve Replacement). Understanding the differences can help you have a more informed conversation with your cardiologist about which approach is right for you.

Understanding the Two Approaches

Surgical Aortic Valve Replacement (SAVR)

Traditional open heart surgery has been the gold standard for aortic valve replacement for over 50 years. The surgeon makes a 6-8 inch incision in the chest, cuts through the breastbone (sternum), and stops the heart using a heart-lung machine. The diseased valve is removed and replaced with a mechanical or biological (tissue) valve. The heart is then restarted, and the chest is closed.

Transcatheter Aortic Valve Replacement (TAVR)

TAVR takes a completely different approach. Instead of opening the chest, the new valve is delivered through a small puncture in the leg (or sometimes the chest). A catheter carries the replacement valve through the blood vessels to the heart, where it's positioned inside the old valve and expanded. The heart continues beating throughout the procedure — no heart-lung machine is needed.

Head-to-Head Comparison

Factor
TAVR
Open Surgery
Incision
Small puncture (leg)
6-8 inch chest incision
Anesthesia
Often conscious sedation
General anesthesia
Heart-Lung Machine
Not required
Required
Procedure Time
1-2 hours
3-5 hours
Hospital Stay
1-3 days
5-10 days
Recovery Time
Days to weeks
2-3 months
Return to Activities
1-2 weeks
6-12 weeks
Driving
Often within 1 week
4-6 weeks
Post-op Pain
Minimal
Significant
Blood Transfusion
Rarely needed
Often needed

What the Research Shows

Multiple large clinical trials have compared TAVR to surgery across all patient risk levels:

  • High-risk patients: TAVR showed similar survival rates to surgery with significantly faster recovery (PARTNER trial, 2011).
  • Intermediate-risk patients: TAVR was non-inferior to surgery for death and stroke, with shorter hospital stays (PARTNER 2, 2016).
  • Low-risk patients: TAVR met endpoints for non-inferiority, and some studies showed advantages in early outcomes (PARTNER 3, Evolut Low Risk, 2019).

Based on this evidence, the FDA has approved TAVR for patients at all surgical risk levels, making it an option for the vast majority of patients with severe aortic stenosis.

Who is a Good Candidate for TAVR?

TAVR may be preferred for patients who:

  • • Are at higher surgical risk due to age or other medical conditions
  • • Have had previous chest surgery (making repeat sternotomy more complex)
  • • Have a heavily calcified aorta ("porcelain aorta")
  • • Want to avoid a long recovery period
  • • Have an active lifestyle and want to return to activities quickly
  • • Have suitable anatomy for the procedure (determined by CT scan)

When Might Surgery Be Better?

Open surgery may still be preferred in certain situations:

  • • Younger patients (under 65) who may benefit from a mechanical valve's durability
  • • Patients who need other heart surgery at the same time (bypass, other valve repair)
  • • Anatomy that isn't suitable for TAVR (bicuspid valve in some cases, certain sizes)
  • • Active infection (endocarditis) involving the aortic valve

The Importance of a Heart Team Approach

The best outcomes come from a "Heart Team" approach where interventional cardiologists, cardiac surgeons, and imaging specialists review each case together. This multidisciplinary evaluation ensures that every patient receives a personalized recommendation based on their unique anatomy, health status, and preferences.

Questions to Ask Your Doctor

If you've been diagnosed with aortic stenosis, consider asking:

  • 1. Am I a candidate for both TAVR and surgical valve replacement?
  • 2. What are the specific risks and benefits of each approach for me?
  • 3. How many TAVR procedures has this hospital/doctor performed?
  • 4. What type of valve would you recommend and why?
  • 5. What does recovery look like, and when can I return to normal activities?

The Bottom Line

Both TAVR and surgical valve replacement are proven, effective treatments for severe aortic stenosis. The "right" choice depends on your individual circumstances, anatomy, and preferences. What matters most is that you receive care from experienced specialists who can offer both options and help you make an informed decision.

If you've been told you need aortic valve replacement — or if you want a second opinion about your options — Dr. Bleszynski is fellowship-trained in TAVR and can help you understand which approach may be best for your situation.

Considering TAVR?

Schedule a consultation with Dr. Bleszynski to discuss whether TAVR is right for you.

Schedule ConsultationLearn About TAVR in Las Vegas

Peter A. Bleszynski, MD, FACC, FSCAI

Interventional Cardiologist, Las Vegas

Medical Disclaimer: This article is for educational purposes only and does not constitute medical advice. Individual treatment decisions should be made in consultation with your physician based on your specific health situation.