Transcatheter aortic valve replacement

What is transcatheter aortic valve replacement (TAVR)?

Transcatheter aortic valve replacement (TAVR) is a procedure used to treat aortic stenosis. Aortic stenosis is a condition where the aortic valve, one of the heart's four valves, thickens and stiffens. This narrowing makes it harder for the heart to pump blood to the rest of the body.

TAVR replaces a diseased aortic valve with a new, artificial valve. Unlike traditional open-heart surgery (also called surgical aortic valve replacement, or SAVR), TAVR is minimally invasive. This means it involves smaller incisions and often results in a shorter recovery time. 

During TAVR, a new valve is delivered to the heart through a catheter, a thin, flexible tube. The catheter is typically inserted into an artery in the groin (most common) or, less often, in the chest. The new valve is then expanded within the old, diseased valve, pushing it aside and taking over its function.

Why is TAVR performed?

TAVR is primarily performed to treat severe aortic stenosis. When the aortic valve narrows, it can cause symptoms such as:

• Chest pain
• Dizziness or fainting
• Shortness of breath
• Fatigue
• Heart palpitations
• Swollen ankles or feet

If left untreated, severe aortic stenosis can lead to serious heart problems, including heart failure. TAVR was originally developed for people who could not safely have open-heart surgery or who faced a high risk of complications from it. Today, TAVR is approved and widely used for people at every level of surgical risk-low, intermediate and high-as well as those who cannot have surgery at all. Whether TAVR or surgery is the better fit depends less on a general risk category and more on your age (AHA guidelines recommend SAVR as the preferred option  for patients under 65 with a life expectancy greater than 20 years), specific heart anatomy, overall health and personal preferences, which your heart team will review with you.

How is TAVR done?

Many TAVR procedures today are completed in one to two hours, though some cases take longer depending on individual anatomy. Most patients receive a lighter form of sedation that keeps them comfortable and relaxed rather than full general anesthesia, although the type of anesthesia used can vary by patient and hospital.

Here is a general overview of the steps involved:

1. Catheter insertion: A small incision is made, usually in the groin, to access a blood vessel. A catheter containing the new valve is then guided through the blood vessel to the heart. In some cases, the incision may be made in the chest.

2. Valve placement: Once the catheter reaches the aortic valve, the new valve is carefully positioned and then expanded. The new valve pushes the old valve leaflets aside and immediately begins functioning.

3. Catheter removal: After the new valve is successfully implanted, the catheter is removed, and the incision site is closed.

Throughout the procedure, the healthcare team monitors your heart function and vital signs. Many patients are up and walking within a few hours afterward, and most go home within one to three days-considerably faster than the typical recovery from open-heart surgery.

How well does TAVR work?

TAVR can improve how your heart works and reduce symptoms such as chest pain, shortness of breath and fatigue. Many people who have TAVR feel better and can be more active afterward.

Studies have shown TAVR to be an effective treatment for aortic stenosis across all risk groups. Patients who undergo TAVR often experience improved survival rates, fewer symptoms and a better quality of life compared to managing the condition with medication alone.

Your heart team will help determine whether TAVR or surgical valve replacement is the right choice for you, based on your anatomy, health history and personal goals.

How do you prepare for the TAVR procedure?

Before the TAVR procedure, a heart  team will conduct a thorough evaluation. This assessment typically includes:

• Medical history review: To understand your overall health and any existing conditions.
• Physical exam: To assess your current physical state.
• Imaging tests: Such as echocardiogram, CT scan, and sometimes MRI, to create detailed images of your heart and blood vessels. These images help the team plan the procedure.
• Blood tests: To check kidney function, blood count and other health markers.
• Consultations: With a cardiologist, cardiac surgeon and other specialists to discuss the procedure and determine if TAVR is appropriate for you.

You will receive specific instructions about preparing for the procedure, including guidelines on eating, drinking and medication use.

After TAVR: When to call

It is important to monitor your health closely after a TAVR procedure. Contact your doctor immediately if you experience any concerning symptoms.

Call 911 if you:

• Experience chest pain or pressure that is severe or does not go away
• Have sudden shortness of breath or difficulty breathing
• Experience sudden numbness or weakness on one side of your body, or trouble speaking or seeing
• Have a sudden, severe headache
• Experience a sudden inability to move your leg or arm
• Have heavy bleeding that does not stop after applying pressure

Contact your doctor if you experience:

• Fever of 100.4 F (38 C) or higher
• New or worsening pain at the incision site
• Redness, swelling or discharge from the incision site
• Swelling in your legs, ankles or feet
• Unusual fatigue or weakness
• Dizziness or lightheadedness
• Palpitations or a racing heart
• Any other symptoms that concern you