What is Transcatheter Aortic Valve Replacement (TAVR)?
Transcatheter aortic valve replacement, commonly known as TAVR, is a minimally invasive medical procedure used to treat aortic valve stenosis. This valvular heart disease occurs when the aortic valve narrows due to age or other factors, preventing it from fully opening and making it difficult for oxygenated blood to pass from the heart into the rest of the body. And without oxygenated blood, which our body uses to make energy, we wouldn’t be able to perform basic functions, such as walking, eating, or thinking.
There are two ways to treat aortic valve stenosis – traditional open-heart surgical aortic valve replacement (SAVR) or the minimally invasive TAVR approach.
At the MemorialCare Heart & Vascular Institute, our goal is to treat complex cardiovascular diseases in the least invasive way possible, as it is not only less severe on the body but leads to a quicker recovery. As one of the region’s most experienced teams trained in minimally invasive, lifesaving procedures, we’re able to treat a full range of heart diseases, including aortic valve stenosis.
While both treatments will replace the diseased valve, their approaches are different. Whereas SAVR requires a surgeon to make a large incision in the chest – including cutting through bone – to access the heart, the less invasive TAVR requires only small incisions made in the leg or chest. The proceduralist is then able to insert a thin tube called a catheter into blood vessels, which is then guided to the diseased area in the heart. Prior to inserting the catheter, a specially designed artificial (bioprosthetic) valve is attached to its end. Once the catheter has reached the heart’s native aortic valve, the new valve is expanded and placed inside the old valve so that it can immediately take over the role of regulating blood flow.
Are there benefits to having the TAVR procedure vs. traditional open-heart surgery?
Minimally invasive procedures are less taxing on the human body. Since TAVR requires smaller incisions than SAVR and does not require splitting open the breastbone or stopping the heart, patients will benefit in the following ways:
- Less pain
- Shorter hospital stay (usually just one night in the hospital)
- Quicker recovery time / faster return to normal activities
- Less scarring
- Reduced complications - less chance of blood loss or infection
What is Aortic Valve Stenosis?
To better understand the function of the aortic valve and what stenosis is, let’s take a quick look at the cardiovascular system, which is the system of blood vessels and muscles that pump blood throughout the body, delivering oxygen and nutrients to cells and removing waste products.
The heart is made up of four chambers, each containing a valve that prevents the backward flow of blood. Blood pumps in one direction through the heart beginning when deoxygenated blood enters the heart’s right atrium, then passes through a valve to the right ventricle before traveling to the lungs via the pulmonary arteries. After picking up oxygen in the lungs, the blood travels back to the heart via the pulmonary veins, enters the left atrium, then passes through a valve to the left ventricle where, finally, it must pass through the aortic valve to reach the aorta, the body’s main artery.
The aortic valve typically consists of three thin flaps, known as leaflets or cusps, which open and close with each heartbeat to control blood flow. But when aortic stenosis occurs, the valve’s leaflets become thickened, stiffened, or calcified over time, reducing their ability to fully open and close. This narrowing restricts the oxygenated blood from flowing from the heart to the body. To compensate, the heart must work harder to push the oxygenated blood through the narrowed aortic valve. This extra effort may cause the left ventricle to thicken (hypertrophy), enlarge, and weaken and, if not addressed, may lead to heart failure.
What causes Aortic Valve Stenosis?
The causes of aortic valve stenosis can vary but it generally occurs as we age, and most commonly, as a result of calcium buildup, or atherosclerosis, which stiffens the valve. Other causes may include congenital heart conditions, infective endocarditis, and rheumatic fever. The severity of aortic valve stenosis ranges from mild to severe and can be affected by these factors:
- High Blood Pressure
- High Cholesterol
- Metabolic syndrome
- Calcification of the valve
What are the symptoms of Aortic Valve Stenosis?
People with aortic valve stenosis can have it for years and not experience symptoms. However, those with symptoms may experience:
- Chest pain
- Shortness of breath
- Fainting or lightheadedness
- Heart murmur
- Heart palpitations
Who is eligible for the TAVR procedure?
The less invasive TAVR is beneficial for patients who are less than ideal candidates for traditional open-heart surgery (SAVR) due to age, frailty, or multiple comorbidities. To find out if you or a loved one would be a good candidate for TAVR, we recommend that you talk with your doctor.
At MemorialCare, our team of interventional cardiologists, cardiac surgeons, imaging specialists, and other health care professionals are here to help determine if this procedure is the most appropriate procedure for you, as eligibility can only be determined after a patient has had a thorough evaluation that includes a comprehensive physical exam and multiple medical tests.
These are some of the key factors they take into account when determining eligibility:
- The severity of the aortic valve stenosis
- The severity and types of symptoms the patient is experiencing
- Age coupled with the patient’s overall health and life expectancy
- Pre-existing medical conditions
- Anatomical suitability
- Assessment of surgical risk between TAVR and SAVR
- Patient’s goals and preferences
These are some of the common evaluations and medical tests your health care team may perform:
- Review of medical history
- Conduct a thorough physical examination
- Echocardiogram (echo) test
- Electrocardiogram (ECG or EKG) test
- Chest X-ray
- Blood tests
- Cardiac catheterization
- Computed Tomography (CT) Scan
- Transesophageal Echocardiography (TEE)
What are the possible risks and complications of Transcatheter Aortic Valve Replacement?
Transcatheter aortic valve replacement (TAVR) is generally considered a safe procedure, and it has significantly lower risks compared to traditional open-heart surgical aortic valve replacement (SAVR). However, like any medical procedure, there are still potential risks and complications associated with TAVR. Some of these include:
- Risk of bleeding at the access site or internally
- Damage to blood vessels such as tearing or rupture
- Aortic valve leakage
- Acute kidney injury
- New prosthetic valve dysfunction
- Coronary obstruction
- Bruising, pain, or infection can occur at the catheter insertion site
- Although the risk is low, TAVR, like any medical procedure, carries a small risk of mortality
What kind of steps can be taken to minimize risks and ensure patient safety?
Minimizing risks and ensuring patient safety during transcatheter aortic valve replacement (TAVR) involves a comprehensive approach that includes careful patient selection, pre-procedure preparation, experienced medical teams, and post-procedure monitoring.
At MemorialCare, our team of cardiac professionals works collaboratively to ensure the best outcomes. Already highly experienced, the team makes it a priority to stay informed on new medical advances and treatments as well as engage in continuous training and skill development.
Additionally, our hospitals regularly engage in quality improvement initiatives to continuously assess outcomes and implement best practices, enhancing patient safety and procedural success.
What can I expect during the Transcatheter Aortic Valve Replacement (TAVR) procedure?
Preparing for TAVR
If you are a good candidate for the TAVR procedure, your MemorialCare surgeon and treatment team will explain what to expect before, during, and after the procedure.
To prepare before the procedure, you may need to:
- Temporarily stop medications
- Restrict food intake before the procedure
- If you smoke, temporarily stop smoking
- Have a dental evaluation (dental infections can lead to complications)
- Undergo pre-operative tests
- Have hair shaved on your body around the planned incision area
During the procedure
The TAVR procedure usually takes from one to three hours, during which the patient is either administered general anesthesia or conscious sedation to keep them comfortable and pain-free during the procedure.
Once the procedure begins, the physician will choose the best access site for the TAVR procedure, typically the femoral artery in the groin area, but alternative access points, such as the chest or carotid artery, may be used if necessary. After cleaning the catheter and preparing it for insertion, the physician will insert a sheath into the chosen access site. Through this sheath, the catheter with the collapsed replacement valve is carefully guided through the blood vessels and into the heart. Once in position, the replacement valve is expanded and deployed within the old, narrowed valve, allowing the new valve to begin functioning immediately. Once the procedure is complete, the catheters and sheaths are removed, and the access site may be closed with sutures or special closure devices.
Throughout the procedure, the medical team will closely monitor the patient’s vital signs, heart rhythm, and oxygen levels to ensure safety and respond to any potential complications promptly.
Post-surgery care and recovery
After the operation, the length of the hospital stay will vary depending on the patient’s condition. Some patients may be discharged within a day or two, while others may require a slightly longer stay for observation and recovery. Throughout their stay, they will be closely monitored, including regular vital sign checks, echocardiograms, and electrocardiograms (ECG or EKG).
After being discharged from the hospital, the patient will need to schedule regular follow-up appointments with their health care team so that they can monitor the patient’s progress and assess the new valve’s function.
Additionally, depending on the patient’s individual needs, a cardiac rehabilitation program may be recommended. Designed to improve a patient’s overall cardiovascular health, patients will receive a personalized program that includes support and guidance on nutrition, exercise and lifestyle changes.
Evaluation to be a candidate for TAVR is offered at:
FAQ about Transcatheter Aortic Valve Replacement (TAVR)
TAVR, or transcatheter aortic valve replacement, is a minimally invasive procedure used to treat aortic valve stenosis. Using small incisions, a catheter with an attached replacement valve is inserted into the body’s vascular system and guided to the heart. TAVR is an alternative treatment to traditional open-heart surgical aortic valve replacement (SAVR), which requires a large incision in the chest.
TAVR has emerged as a valuable treatment option for patients with severe aortic stenosis. Since 2011, when the first transcatheter aortic valve replacement device was approved, the number of U.S. patients who have undergone the procedure has reached more than 300,000 and continues to increase. Additionally, the continuous improvement in TAVR technology and devices has made the procedure safer and more effective, further contributing to its widespread adoption.
The success rate of transcatheter aortic valve replacement (TAVR) depends on a number of factors, including the patient’s age, the severity of the underlying valve disease, the experience of the medical team performing the procedure, and the specific device used. Generally speaking, the procedure has demonstrated a high success rate in treating aortic valve stenosis and in significantly improving the symptoms related to it, such as shortness of breath, chest pain, and fatigue.
While the vast majority of patients are successfully treated, it is important to note that TAVR is still a minimally invasive procedure and carries the risks of any procedure, including bleeding, infection, and stroke. For this reason, patients should discuss the risks and benefits of TAVR with their doctors in order to make an informed decision.
The recovery time for TAVR is generally shorter compared to traditional open-heart surgery. However, the exact recovery period is dependent on the individual and such factors as age, overall health, etc. In general, a patient will spend at least one night in the hospital. And while the time it takes to resume normal day-to-day activities can vary, some patients may be able to engage in light activities within a few days to a week after the procedure, while others may require a bit more time.
To help reach full recovery, a patient may also be prescribed medications to manage pain, prevent infection and reduce blood clots, attend multiple follow-up appointments to monitor progress and participate in a cardiac rehabilitation program.
The duration of the transcatheter aortic valve replacement (TAVR) procedure can vary depending on several factors, including the complexity of the patient’s condition, the specific approach used, and the type of TAVR device being implanted. On average, the TAVR procedure typically takes around one to three hours from the time of anesthesia induction to the completion of the valve deployment.
Additional time may be required for pre-procedure preparation, recovery from anesthesia, and post-procedure observation and monitoring.
It’s important to understand that TAVR is a relatively newer procedure (since 2011), and long-term data on valve durability is still being collected and studied. Nonetheless, TAVR valves have shown promising long-term outcomes, and studies suggest that they can last for a considerable period. We recommend that patients who receive a TAVR valve should have regular follow-up appointments with their health care team to monitor the valve’s function and assess any changes over time.
Additionally, the type of TAVR valve used can affect durability. TAVR valves are available in different designs and materials. They are made of bioprosthetic tissue (usually from animal sources such as bovine or porcine) and are generally estimated to last at least 10 to 15 years.
Cardiac rehabilitation is a comprehensive and structured program that aims to help patients recover from heart-related procedures, surgeries, or cardiac events. It involves supervised exercise, education on heart-healthy lifestyle changes, and support for physical and emotional well-being.
The need for cardiac rehabilitation after a transcatheter aortic valve replacement (TAVR) procedure depends on the individual patient’s health status and overall condition. Therefore, MemorialCare’s cardiac team will assess and determine the need for cardiac rehabilitation on a case-by-case basis.
TAVR (transcatheter aortic valve replacement) and SAVR (surgical aortic valve replacement) are two different procedures used to treat the same underlying condition — aortic valve stenosis. TAVR uses a minimally invasive procedure to replace the diseased valve. Through small incisions, a catheter delivers the replacement valve to the heart. In contrast, SAVR is far more invasive as it involves a full sternotomy (cutting the breastbone), placing the patient on a heart-lung bypass machine, and stopping the heart during valve replacement.
While both TAVR and SAVR are effective procedures, they may not be equally appropriate for all patients. Therefore, a team of cardiac specialists will assess the most suitable and effective treatment options on a case-by-case basis.