What is TAVR?
Transcatheter aortic valve replacement (TAVR), also known as transcatheter aortic valve implantation (TAVI), is a minimally invasive procedure used to treat narrowing of the aortic valve. This narrowing, called aortic stenosis, hinders the heart's ability to pump enough oxygenated blood to the body. By replacing the faulty native valve with an artificial valve through small incisions or a catheter, the TAVR procedure improves blood flow from the heart.
How does TAVR work?
During a Transcatheter Aortic Valve Replacement procedure, the faulty native aortic valve is accessed through the femoral artery or a small incision in the chest wall. A collapsible prosthetic valve is delivered via catheter to the heart. Once in place, the valve is expanded inside the aortic valve site. This causes the prosthetic valve leaflets to take the place of the native leaflets. The diseased native valve is essentially pushed aside. Blood can then flow more freely from the left ventricle through the new artificial valve and into the aorta. TAVR essentially provides a minimally invasive alternative to open-heart surgery for high-risk patients with severe aortic stenosis.
Who is a candidate for TAVR?
Not all patients with aortic stenosis require surgical valve replacement. The TAVR procedure is reserved for patients who cannot undergo or are at high risk from conventional open-heart surgery. This includes individuals with severe comorbidities such as:
- Advanced age (usually 75 years or older)
- Previous heart surgery
- Lung disease
- Kidney disease
- Mobility issues
-Additional valve problems
- Weakened immune system
Your physician will evaluate your risk factors and symptoms to determine if you are a candidate for TAVR. The heart team will discuss options and ensure TAVR is the right choice given your medical history and condition.
The TAVR procedure
At the day of the operation, the patient is taken to the catheterization lab. The heart team includes an interventional cardiologist, cardiac surgeon, and anesthesiologist. Sedation is administered and local anesthetic applied. Access is gained through the femoral artery or a small incision in the chest wall.
A guidewire is passed through the blocked valve. A delivery catheter containing the compressed prosthetic valve is advanced over the wire and into the heart. Using X-ray and ultrasound imaging for guidance, the new valve is precisely placed across the diseased native valve.
When in the right position, the artificial valve frame is expanded to lock into place. As it expands, the native leaflets are pushed aside. The catheter is then removed, leaving the replacement valve in function. The procedure typically takes 1-2 hours. Patients usually stay in the hospital for 1–5 days, depending on their recovery.
Rehabilitation and follow-up
After transcatheter aortic valve replacement, mobilization slowly increases as patients regain strength. Most feel improvements quickly as their hearts can now pump more efficiently. Medications may be adjusted by your doctor. Careful follow-up is important to monitor valve function and address any issues promptly. The prosthetic valves last 10-20 years on average before potentially needing replacement. Overall, high-risk patients have been shown to experience improved symptoms and quality of life with TAVR compared to medical management alone.
Risks of TAVR
As with any open-heart surgery, TAVR does carry procedural risks including:
- Bleeding at the catheter insertion site
- Damage to nearby structures like the heart, blood vessels, or valves
- Stroke from debris or clots
- Heart attack from blockages during the procedure
-Valve complications like leakage, migration, injury or blockage
- Pacemaker implantation if the procedure affects heart rhythms
- Infection of the replaced valve or bloodstream
However, studies show TAVR has lower risks of mortality and complications compared to open-heart surgery in high-risk patients. By discussing your goals of care with the heart team and weighing options carefully, the benefits of the TAVR procedure often outweigh risks for the right candidates. Ongoing research continues to expand safety and long-term outcomes.
TAVR provides an important treatment option for individuals with severe aortic stenosis who otherwise could not tolerate surgical replacement of the aortic valve. Advances in technology now allow many high-risk patients to benefit from this minimally invasive procedure as an alternative to open-heart surgery. By understanding the TAVR process and working closely with your heart team, you can feel well-prepared for what to expect.
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