Making a Decision

Making a Decision About Treatment Based on What is Important to You

Today, many patients have the option of having their aortic valve replaced using either a surgical or transcatheter approach. Understanding your personal preferences and risks when deciding between these two treatments will help you choose the option that is right for you. The ADVICE team has developed a decision-assistance tool, also referred to as a risk calculator that estimates your likelihood of death, stroke, being discharged to home, and number of days alive and out of the hospital in the first year after treatment with each of the two treatment options. Patients can work through the risk calculator on their own or with their doctor.

In addition to using the risk calculator and reviewing the report with your physician, the following tips may help you with the decision process:

  • Get the facts. Understand what is generally known about expected results with SAVR and TAVR, and in particular with the surgeon(s) you are considering.
  • Define your goals for having your aortic valve replaced.
  • Assess where you are considering having the treatment done. What can you learn about the strengths and weaknesses of the program, their experience with TAVR and SAVR, and their outcomes? For example, ask questions such as: How many procedures or surgeries do they complete a year?" What is their mortality rate? What is their stroke rate?
  • Ask your primary care physician, family, friends, religious advisors, and other people who know you and might help you make the best decision.
  • Get a second opinion

Take the time to talk with your provider about both your expected treatment outcomes and what you hope to gain from the AVR procedure. Are there potential complications that weigh most heavily on your mind?  Will one procedure or the other be expected to minimize the risk of these complications? Will having your valve replaced at another hospital or center that performs more procedures potentially reduce risks? Are there other things you can do to help minimize the risk of these complications?  Nothing can replace an open, honest discussion with a provider who understands you and understands the treatment options available to you.

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Getting

A SECOND OPINION

A second opinion means you are consulting with another doctor to confirm a diagnosis and/or find possible different treatment choices available to you. It is common practice and acceptable to seek a second opinion, and additional information never hurts and may help. If you choose to get a second opinion, it is recommended that you schedule an appointment as soon as possible to avoid delays in your treatment and recovery.

You may be worried about telling your doctor that you want a second opinion; however, most doctors welcome another physician’s input and often will be able to recommend someone. For more information about seeking a second opinion visit the Patient Advocate Foundation.