Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure that involves replacing the aortic valve in people with aortic stenosis. It has several benefits over open heart surgery, such as a smaller incision, faster recovery, and shorter hospital stay.
Transcatheter aortic valve replacement (TAVR) is a procedure that replaces an aortic valve that’s not working well. This procedure is also called transcatheter aortic valve implantation (TAVI).
TAVR differs from other types of valve replacement procedures because it uses a minimally invasive approach. Minimally invasive procedures use a much smaller incision than open surgeries.
This article will explain when TAVR is done, what to expect from the procedure, and the benefits and risks associated with a TAVR procedure.
TAVR is done to treat aortic stenosis. This is a condition where the aortic valve, which opens to allow blood flow from your heart to the rest of the body, has become too narrow.
When this happens, less blood leaves the heart, causing symptoms like fatigue, lightheadedness, chest pain, and shortness of breath. When left untreated, complications like heart failure and death can occur.
A TAVR procedure may be recommended if:
severe aortic stenosiscauses symptoms
- the patient is over 65 years old
- certain risk factors make open heart surgery more dangerous
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In some cases, people may not be eligible for open heart valve repair surgeries due to factors like age and other health conditions. In these situations, a less invasive approach, like the TAVR procedure, may be recommended.
TAVR is typically done in a hospital by a cardiologist. This is a doctor who specializes in treating conditions that affect the heart.
The procedure can be done under conscious sedation or general anesthesia. Under conscious sedation, you’ll be awake but won’t feel pain. Under general anesthesia, you’ll be asleep. Overall, TAVR takes 1 to 2 hours.
Before the procedure
Prior to recommending TAVR, your doctor will do tests to make sure that the procedure is right for you. These tests can include, but aren’t limited to:
- blood tests that can give your doctor an idea of your overall health
- electrocardiogram (ECG), which assesses your heart’s electrical activity
- echocardiogram, an ultrasound that displays a live image of how your heart valves and chambers are working
- CT scan, which uses X-rays and a special dye to help your doctor see your heart and blood vessels, especially those in the legs
- coronary angiogram, which allows your doctor to see how blood is flowing through the blood vessels that supply your heart
Prior to the TAVR procedure, your doctor will give you instructions on how to prepare. This can include when to stop eating or drinking, and whether or not to stop taking some medications or supplements.
When you arrive at the hospital:
- You’ll be directed to an area where you’ll change into a hospital gown and remove any jewelry.
- You may be given medication to keep you calm before your procedure.
- An IV will be placed into a vein in your hand or arm.
- Machines will help monitor your vital signs, such as blood pressure, heart rate, and blood oxygen levels.
During the procedure
During the TAVR procedure, your doctor will make a small incision. The most common place to do this is in the groin or thigh. However, other areas can also be used, such as the chest or under the collarbone.
After making the incision, your doctor will direct a thin, flexible tube called a catheter into a blood vessel. The replacement valve, which is made from animal tissue, is folded up within the catheter.
Using imaging technology, the catheter is guided through the blood vessels to your heart. The replacement valve is placed inside the existing, diseased valve. Once expanded, it pushes existing valve tissue out of the way and serves as a new aortic valve.
Before removing the catheter, your doctor will check to make sure that the replacement valve has been placed correctly and that there are no detectable problems with the function of the replacement valve or your heart.
After the procedure
After your TAVR procedure is over, you’ll be taken to a recovery room for monitoring. You’ll typically need to stay in the hospital for at least 1 to 2 days.
When it’s time to leave the hospital, your doctor will give you instructions on how to care for your incision as well as when you can resume certain activities. Be sure to follow their instructions carefully.
You may also be given medication to help with your recovery. These may be:
- medications to help with pain or discomfort
- medications to reduce the risk of blood clots
About a month after your TAVR procedure, you’ll need a follow-up visit to check on your recovery and see how well your replacement valve is working.
There are several benefits to the TAVR procedure over procedures like open heart surgery. For example, TAVR:
- can be used in people with high surgical risk
- may improve health and quality of life in people who otherwise had few options for valve repair
- is minimally invasive, requiring a much smaller incision
- typically requires a shorter hospital stay
- has a faster recovery time
Who should not have TAVR?
Although there are many benefits to TAVR, the procedure isn’t recommended for everyone. Some examples where TAVR wouldn’t be recommended include having:
- certain congenital heart valve defects or severe valve calcification
- heart valve infection (endocarditis)
- life expectancy of less than a year
- an inadequate site for vascular access
Generally speaking, the TAVR procedure is safe, with few people experiencing serious complications. However, as with any procedure, TAVR comes with some risks. These can include:
- bruising, bleeding, or pain at the incision site
- blood clots, which can lead to stroke or heart attack
- arrhythmias, which in some cases may require a pacemaker
- kidney damage
- damage to the blood vessel in which the catheter was inserted
- damage to the heart and surrounding blood vessels
- leaking at the replacement valve, which can lead to a second TAVR procedure or open heart surgery to fix
Compared to surgery, TAVR has an increased risk of some complications. These
- leaking of the replacement valve
major blood vessel-related complications
- needing to have a pacemaker implanted
- requiring a second surgery
Following your TAVR procedure, your doctor will inform you about potential complications. Be sure to seek care promptly if you experience severe or concerning symptoms.
Earlier research into TAVR focused on people who were at high risk from surgical aortic valve repair. More recently, the effectiveness of TAVR has been studied in people with low and intermediate risk of surgical complications.
Here’s what the research has shown about the effectiveness of TAVR in these groups:
- High surgical risk group: Studies show mixed results.
One studydetermined that patients who had TAVR had a higher quality of life 1 year after the procedure. According to another study, TAVR patients had similar improvements as patients who had open heart surgery. Another, more recent study assessing 5-year outcomes, also showed minimal benefits compared to surgery. Additionally, more people who had had TAVR required a pacemaker.
- Intermediate surgical risk group: This study showed that at 5 years, people with severe aortic stenosis at intermediate surgical risk had similar rates of death and stroke as surgical patients.
- Low surgical risk group: This group had similar findings for death and stroke with TAVR versus surgical options.
TAVR is a minimally invasive procedure to replace the aortic valve in people with severe aortic stenosis. It has several benefits over surgery, especially for people who are at a high risk of complications from open heart surgery.
Typically, the TAVR procedure lasts about an hour or two and requires a short hospital stay. Your doctor can give you a better idea of what to expect.
TAVR isn’t recommended for everyone, as the risks may outweigh the benefits for some people. If you have aortic stenosis, your doctor can use your medical history and various tests to determine if you’re a good candidate for TAVR.