Two options for valve surgery

Dear Doctors: My wife’s aortic valve needs replacing. We have two options: transcatheter replacement of the valve, or cracking the breastbone open to reach the valve. Most of the articles we have read suggest the catheter approach. My wife’s cardiologist said that method is too experimental and the possibility of infection is greater. My wife is 81, has maintained her current weight of 100 pounds on a body of 5 feet 1 inch for 30 years, and is in good physical shape. — A.G.

The catheter replacement of the aortic heart valve involves using a thin, pliable tube — a catheter — to transport the new valve into the heart by introducing the catheter into a surface vessel and inching it to the desired heart location. With surgery, the sternum (breastbone) has to be split for the surgeon to reach the heart and the site for the valve replacement. There is no argument that the catheter approach is easier on the patient. However, the chest approach has been around for a longer time, and heart surgeons are more familiar with it.

The immediate outcome of surgery and transcatheter replacement are equally good, and remain equally good for two years. Later, leakage of the valve happens more often to the transcatheter-placed valves.

Currently the surgical replacement of the valve is the mainstay treatment for reasonably healthy people.

It’s best to discuss this matter with the surgeon who will do the operation. You’ll hear both sides of the story.