If you or a loved one is living with aortic stenosis, or the narrowing of the aortic valve in the heart, you may be recommended for a procedure to replace your existing stenotic valve. The good news is there is a minimally invasive option called transcatheter aortic valve replacement (TAVR).
Because it’s minimally invasive, TAVR patients can recover more quickly and spend less time in the hospital.
Here are some things I tell my patients about the procedure, including the risks and benefits.
A closer look at TAVR
TAVR is a minimally invasive procedure used to treat aortic valve stenosis without major surgery. Aortic valve stenosis occurs when the aortic valve — the last door for blood to leave the heart — thickens or becomes stiff and can no longer open fully. That reduces the flow of blood throughout the body and forces the heart to work harder, causing symptoms such as shortness of breath, chest pain, and fatigue. Over time, aortic valve stenosis can also damage the heart muscle and lead to heart failure, loss of consciousness and death.
The TAVR procedure uses a thin, flexible tube called a catheter to replace the damaged aortic valve. It starts with skin incisions — usually in a patient's groin, but sometimes under the collarbone, between the ribs, at the base of the neck, or in the abdomen. From the incision point, the catheter is guided up to the heart. The catheter contains either a self or balloon-expandable valve.
When the catheter device reaches the aortic valve, the new valve is inflated, often using a balloon on the tip of the catheter. At this point, the new valve takes over the job of regulating blood flow. Once the valve is secured, the catheter is removed, and the incision is closed.
The entire procedure only takes about an hour.
One of the advantages of TAVR is the short recovery time. Patients need to stay in bed for at least several hours for monitoring after they wake up. But once it's confirmed that they're recovering normally, they're allowed to get up and move around. In many cases they're even able to go home the next day.
Most patients begin a cardiac rehabilitation program within several days of having TAVR. They'll also be prescribed blood thinners and antibiotics to reduce the risk of blood clots or infections. I like to see patients for a followup appointment four to six weeks after their procedure. That gives me a chance to see how they're healing and test the function of their new valve.
The benefits of TAVR
There are a number of reasons why I like to recommend TAVR to appropriate patients.
- It's less invasive. Unlike open-heart surgery, requiring a large incision in the chest, TAVR is performed using a small incision and a thin, flexible tube called a catheter to reach the heart valve.
- It's an option for high-risk patients. Patients who need aortic valve replacement are at high risk for complications. TAVR is a good alternative because it is not as invasive.
- The hospital stay is shorter. Patients often are able to go home the day after their TAVR procedure.
- Recovery is faster. Many people can begin getting back to their normal activities — like driving and exercising — within days to weeks. You should confirm your individual timeline with your doctor before resuming activity.
The risks of TAVR
TAVR, as with all heart procedures, is not entirely without risk. TAVR may cause bleeding, infection, blood vessel complications, problems with the replacement valve, stroke, heart rhythm problems, kidney disease, or heart attack. It's important to discuss these risks with your cardiologist before choosing to undergo TAVR.
Who's a good candidate?
I typically recommend TAVR to patients with severe aortic stenosis that causes symptoms such as chest pain, fatigue, fainting, or shortness of breath. It's also used for those who already have a replacement valve that isn't working as well as it should. The procedure is generally available for patients who are at low, intermediate, or high risk for standard valve replacement.
However, TAVR may not be appropriate for people who were born with heart defects or who have severe weakening of the heart, additional heart valve problems — such as mitral valve regurgitation — or severe kidney disease. It's also not a good fit for those who have had a heart attack within the last month or who have recently experienced a stroke or a transient ischemic attack, or TIA (often called a warning stroke).
I encourage anyone who is considering TAVR to talk with their heart doctors. You can discuss your personal risk factors to determine whether the procedure is right for you.
Experts at treating aortic valve disease
Our team of experts at Temple’s Aortic Valve Disease Program have extensive experience performing TAVR and other types of valve treatments. You can request an appointment with one of our experts or call 800-TEMPLE-MED (800-836-7536).
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