Transcatheter Aortic Valve Replacement (TAVR)
Transcatheter Aortic Valve Replacement is a minimally invasive procedure to repair the heart valve without removing the existing, malfunctioning valve. Instead, the replacement valve is delivered to the malfunctioning valve site and takes over from the old valve by essentially pushing it out of the way.
In the past, patients who needed a valve replacement required invasive open heart surgery, but those with an intermediate risk of surgery may not have been able to have the operation at all. TAVR offers an option for qualifying patients that minimizes many of the risks open-heart valve replacement. Benefits and risks will be discussed in greater detail below and during consultation.
How Does TAVR Work?
The replacement valve used in the TAVR procedure is delivered to the appropriate location using a long, thin diagnostic and treatment device known as a cardiac catheter. Cardiac catheterization allows for deployment of treatment devices via blood vessels without the need for open heart surgery.
Your surgeon will decide how best to access the malfunctioning valve. In some cases, the catheter is inserted into the femoral artery in the groin and threaded to the heart. The malfunctioning valve can also be accessed through at small incision in the chest. The catheter will then be inserted through an artery in the chest or directly into the heart through the tip of the left ventricle. The decision of how to access the valve is decided based on a patient evaluation and the preference of the surgeon. Both methods offer similar results and safety.
Once the replacement valve is placed, most patients recover quickly, requiring only a 3 to 5 day stay in the hospital. Once discharged, patients often return to normal activity within a week, and while individual patients may have some lifestyle restrictions, most patients can perform normal activities within their physical abilities and limits.
Do I Qualify for A TAVR Procedure?
TAVR is not yet approved for every patient that requires a valve replacement. Typically, the ideal candidate for a TAVR is one who is suffering from severe aortic stenosis and for whom open surgical valve replacement procedures may present intermediate risk. As a result, most patients who undergo the TAVR procedure are of advanced age and/or have various medical conditions that create an elevated perioperative risk.
While the procedure is only approved for those with intermediate surgical risk, an excellent track record of safety and effectiveness has led to TAVR being considered for lower risk surgical patients as well. Clinical trials are ongoing to demonstrate whether TAVR is safe and effective for this lower risk population.
Benefits of TAVR
For those that qualify, the benefits of TAVR are significant. Clinical data shows significantly reduced mortality at all postoperative stages, as well as a reduction in postoperative complications. Because the procedure is performed in a minimally invasive manner, patients will have a lower risk of complication, such as infection and blood loss when compared to open-heart surgery. Further, recovery time and return to normal activity is significantly shorter then with traditional valve replacement. Lastly, cosmetically, the TAVR procedure offers significant advantages over open surgery including less scarring.
Most importantly, this procedure has given a new option for those patients with intermediate surgical risk that may not have otherwise been able to undergo a life changing valve replacement.
Risks of TAVR
As with any surgical procedure, TAVR comes with risk. These risks can be minimized by employing a surgeon experienced in the procedure. Some risks may include:
- Bleeding, infection, heart attack or stroke
- Complication associated with the fluoroscopy (x-rays) used to guide the catheter
- The potential of the new valve slipping or leaking. This is most often due to improper sizing and placement and is mitigated with surgeon experience
- The potential to develop irregular heartbeats (arrhythmias)
- Potentially requiring a permanent pacemaker
- And other risks that will be discussed during consultation
These risks will be weighed against the effectiveness of the procedure using comprehensive pre-procedure testing.