Is open heart surgery a procedure of the past?

When I was 12 years old, I was diagnosed with bicuspid aortic valve (BAV), a genetic condition in which my aortic valve has two leaflets to pump blood, instead of the normal three leaflets of the tricuspid aortic valve (TAV). Although this condition causes no consequences to me or most patients with it, it does increase our chances in developing heart conditions later in life. By having two leaflets do the work of three, I am at risk for developing aortic stenosis, a condition where the aortic valve narrows, which reduces or blocks blood flow to the rest of the body (Aortic Valve Stenosis, Mayo Clinic). 

Traditionally, patients such as myself often had to reconcile with the idea that we may have to undergo open heart surgery for a valve replacement as we get older. However, advancements in modern surgical technologies have been paving the way for minimally invasive valve replacement procedures. 

Patients with the normal, three leaflet aortic valve also experience aortic stenosis, especially if they are at risk for cardiovascular disease. Nowadays, the common procedure for aortic stenosis is Transcatheter Aortic Valve Replacement (TAVR), a minimally invasive procedure where a replacement valve is fed to the heart through the femoral artery by a small incision in the groin (TAVR, Johns Hopkins). 

Although TAVR is now a commonplace procedure for aortic stenosis, little research has been done to assess its efficacy in patients with BAV, especially young patients such as myself who are at low surgical risk. 

A recently published article in JAMA carried out a registry-based cohort study comparing 3,243 BAV patients with 34,417 TAV patients, all of whom were at low risk for surgery and underwent TAVR. Their primary outcomes looking at deaths and strokes showed no statistical difference between the two groups at 30 days and 1-year. Secondary outcomes such as surgical complications and quality of life were also not statistically different between the two groups. 

With this comparative study, physicians can now recommend TAVR for BAV patients, just as they have been doing so for TAV patients. Having said that, one limitation is that no study has compared TAVR to open heart surgery in BAV patients. But for right now, this study represents hope for patients with bicuspid aortic valve because it now opens the new frontier for minimally invasive valve replacements, potentially making open heart surgery a procedure of the past. 

References: 

Makkar RR, Yoon SH, Chakravarty T, et al. Association Between Transcatheter Aortic Valve Replacement for Bicuspid vs Tricuspid Aortic Stenosis and Mortality or Stroke Among Patients at Low Surgical Risk. JAMA. 2021;326(11):1034-1044. doi:10.1001/jama.2021.13346. 

“Aortic Stenosis”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/symptoms-causes/syc-20353139.

“TAVR”. Johns Hopkins. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/transcatheter-aortic-valve-replacement-tavr.