Aortic valve replacement by TAVI / TAVR in the very elderly patient. Dr. Anton Titov, MD. A clinical situation example. Is there a clinical case you could discuss? Please discuss a medical situation that illustrates some of the points that we discussed in our conversation today. Dr. Tsuyoshi Kaneko, MD. Yes, so I really want to tell a case. The message here is about how the future is going to be like in the field of cardiac surgery. Dr. Tsuyoshi Kaneko, MD. I had two similar 90-year-old patients. The first 90-year-old patient who was treated about ten years ago, received open-heart surgery to replace aortic valve. He was a very very healthy 90-year-old. He was very functional. He did very well after the operation. He spent about a week in the hospital. He then admitted back in the hospital in about six weeks. He was still trying to recover, he had some fluid in the chest. We injected a lot of Lasix, a diuretic. Eventually he recovered. But it took him over six months. It took about six to eight months for him to completely regain strength and feel better. This is a 90-year-old patient. So he basically wasted six months of his remaining time. On the other hand, I recently treated another 90-year-old man. He was very healthy. But today we can treat aortic stenosis with TAVR. Dr. Tsuyoshi Kaneko, MD. This very old patient got TAVR. TAVR is the minimally invasive Transcatheter Aortic Valve Replacement. That's correct. We went through the groin to put a catheter via femoral artery. There was no need for open chest surgery. We did this without general anesthesia. Patient was awake during the whole time of TAVR (Transcatheter Aortic Valve Replacement). After the TAVI procedure he did well. He left the following day, on postoperative day #1. Dr. Tsuyoshi Kaneko, MD. We saw him about a month later in outpatient clinic. He was going to his yard, he was working on his garden, he was doing very well. One year after minimally invasive TAVR heart procedure he is feeling better than ever. I'm not saying that TAVR is completely better than surgical aortic valve replacement. Dr. Anton Titov, MD. But you can see that the recovery is completely different. For a 90-year-old patient fast recovery time after procedure is something that really does not appear in the medical literature. Importance of faster recovery is not discussed. I think that faster recovery after TAVR is very important. Dr. Anton Titov, MD. Patients are spending less time in the hospital, going back to what they liked before. I think that quality of life component is something that is really undervalued in TAVI / TAVR. It's very hard to measure, but it's undervalued. Dr. Tsuyoshi Kaneko, MD. I think there is going to be more and more of these minimally invasive procedures in the future. There are multiple transcatheter devices for the mitral valve. There are transcatheter devices for the tricuspid valve. There are transcatheter devices for ascending aortic aneurisms. All those are currently being investigated. I think all these minimally invasive procedures are being developed. We will soon see a dramatic change towards minimally invasive cardiac surgery. Dr. Anton Titov, MD. That is, fortunately or unfortunately, the traditional open-heart surgery will diminish. We still have to know how to do open heart surgery. Dr. Tsuyoshi Kaneko, MD. But I think the traditional method of open-heart surgery will decrease. We have to be prepared. But at the same time that will provide better care for the patients. That is why we are here. I think we are very excited to be in cardiac surgery field now. I'm very very excited for the heart disease patients in the future. Dr. Anton Titov, MD. These are very very interesting cases, they do indicate what the future brings. Yes, and I think we are heading towards there. Dr. Tsuyoshi Kaneko, MD. I think five years ago nobody imagined that TAVR will be so successful. I think five years from now there are new devices that we didn't imagine at this time. I think times in heart surgery are moving very fast. Dr. Anton Titov, MD. Thank you very much, Dr. Kaneko! I hope to come back to you in the future. Hopefully we will be able to talk more about the minimally invasive heart procedures. Dr. Tsuyoshi Kaneko, MD. Yes, thank you so much!