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Transcatheter aortic valve replacement (TAVR)

Overview

Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure to replace a narrowed aortic valve that fails to open properly (aortic valve stenosis). Transcatheter aortic valve replacement is sometimes called transcatheter aortic valve implantation (TAVI).

TAVR may be an option for people who are considered at intermediate or high risk of complications from surgical aortic valve replacement. TAVR may also be indicated in certain people who can't undergo open-heart surgery. The decision to treat aortic stenosis with TAVR is made after consultation with a multidisciplinary group of medical and surgical heart specialists who together determine the best treatment option for each individual.

TAVR can relieve the signs and symptoms of aortic valve stenosis and may improve survival in people who can't undergo surgery or have a high risk of surgical complications.

Transcatheter aortic valve replacement (TAVR)

Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure to replace a narrowed aortic valve that fails to open properly (aortic valve stenosis). In this procedure, doctors insert a catheter in your leg or chest and guide it to your heart. A replacement valve is inserted through the catheter and guided to your heart. A balloon is expanded to press the valve into place. Some TAVR valves are self-expanding.

Why it's done

Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure to replace the aortic valve in people with aortic valve stenosis.

Aortic valve stenosis — or aortic stenosis — occurs when the heart's aortic valve narrows. This narrowing prevents the valve from opening fully, which obstructs blood flow from your heart into your aorta and onward to the rest of your body. Aortic stenosis can cause chest pain, fainting, fatigue, leg swelling and shortness of breath. It may also lead to heart failure and sudden cardiac death.

Who benefits most from TAVR

TAVR may be an option if you have aortic stenosis that causes signs and symptoms. For instance, people who are candidates for TAVR may include those who are considered at intermediate or high risk of complications from surgical aortic valve replacement. Conditions that may increase the risk of surgical aortic valve replacement include lung disease or kidney disease — which increase your risk of complications during surgical aortic valve replacement.

TAVR may also be an option if you have an existing biological tissue valve that was previously inserted to replace the aortic valve, but it isn't functioning well anymore.

Before TAVR, you'll need to be tested and evaluated by a multidisciplinary team of heart valve specialists. Doctors will evaluate your condition to determine the most appropriate treatment.

Risks

Transcatheter aortic valve replacement (TAVR) carries a risk of complications, which may include:

  • Bleeding
  • Blood vessel complications
  • Problems with the replacement valve, such as the valve slipping out of place or leaking
  • Stroke
  • Heart rhythm abnormalities (arrhythmias)
  • Kidney disease
  • Heart attack
  • Infection
  • Death

How you prepare

You may be given certain instructions to prepare for your transcatheter aortic valve replacement (TAVR) procedure. Your treatment team will discuss with you how to prepare for the procedure and what to expect during the procedure. Discuss with your treatment team any questions you may have about the procedure.

You may need to have your hair shaved off at the location of your body where the procedure will take place.

Food and medications

Talk to your doctor about:

  • When you can take your regular medications and whether you can take them before your procedure
  • When you should stop eating or drinking before the procedure

Clothing and personal items

Your treatment team may recommend that you bring several items to the hospital including:

  • A list of your medications
  • Eyeglasses, hearing aids or dentures
  • Personal care items, such as a brush, comb, toothbrush and shaving equipment
  • Loosefitting, comfortable clothing
  • Items that may help you relax, such as portable music players or books

During your procedure, avoid wearing:

  • Jewelry
  • Eyeglasses
  • Contact lenses
  • Dentures
  • Nail polish

Other precautions

Talk to your doctor about:

  • Any medications you have brought to the hospital and when you should take medications on the day of the procedure
  • Allergies or reactions you have had to medications

What you can expect

Transcatheter aortic valve replacement (TAVR) involves replacing your damaged aortic valve with one made from cow or pig heart tissue, also called a biological tissue valve. In some cases, a TAVR biological tissue valve may also be placed in an existing biological tissue valve that is no longer working in order to replace it.

Before the procedure

You'll be evaluated to make sure you don't have any risk factors that may affect you during the TAVR procedure.

You may be given a medication to reduce the risk of infection prior to your procedure.

During the procedure

You may receive general anesthesia before the TAVR procedure. A treatment team member will give you medication through an intravenous line to prevent blood clots.

Your treatment team will monitor your heart function and rhythm, and watch for changes in heart function that may occur. Changes in function can be managed with treatments as needed during the procedure.

During TAVR, doctors may access your heart through a blood vessel in your leg. Alternatively, your doctors may conduct the procedure through a tiny incision in your chest, and access your heart through a large artery or through the tip of the bottom left chamber of your heart (left ventricle). Doctors may sometimes use other approaches to access your heart.

In TAVR, a hollow tube (catheter) is inserted through the access point. Your doctor uses advanced imaging techniques to guide the catheter through your blood vessels, to your heart and into your aortic valve.

Once it's precisely positioned, a balloon is expanded to press the replacement valve into place in the native aortic valve. Some valves can expand without the use of a balloon.

When your doctor is certain the valve is securely in place, the catheter is withdrawn from your blood vessel or from the incision in your chest.

After the procedure

You may spend the night in the intensive care unit for monitoring after your procedure. Generally you'll spend about two to five days recovering in the hospital.

You'll need to take blood-thinning medications to prevent blood clots after the procedure. Your doctor will discuss with you how long you may need to take these medications.

Your doctor will recommend that you take medications before certain dental procedures to prevent certain infections, as you're at higher risk of certain infections with a replacement heart valve. Talk to your doctor about his or her recommendations.

Possible catheter access sites in transcatheter aortic valve replacement (TAVR)

Transcatheter aortic valve replacement (TAVR) may be conducted using a catheter inserted through a blood vessel in the leg, the bottom tip of the heart or a large artery in the heart. Doctors may also use other approaches to access the heart.

Transcatheter aortic valve replacement (TAVR) procedure approaches

Doctors may use several approaches to access the heart with a catheter to perform transcatheter aortic valve replacement (TAVR). Approaches include access through a blood vessel in the leg (transfemoral), access through a large blood vessel in the heart (transaortic) and access through the bottom tip of the heart (transapical).

Results

Transcatheter aortic valve replacement (TAVR) can improve the lives of people with aortic stenosis who can't have surgery or for whom surgery is too risky. In these people, TAVR can reduce the risk of death. TAVR may also relieve the signs and symptoms of aortic valve stenosis and improve overall health.

Some studies have found that TAVR has similar mortality rates as heart valve surgery in people with aortic stenosis who have an intermediate or high risk of complications from open-heart surgery.

You may need to continue taking certain medications after your procedure. Take your medications as prescribed.

You'll likely need regular follow-up appointments with your doctor. Let your doctor know if you have any new or worsening signs or symptoms.

Your doctor may recommend that you make healthy lifestyle changes, such as eating a heart-healthy diet, exercising regularly, maintaining a healthy weight and avoiding smoking.

Last updated: March 21st, 2018

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