Transcatheter aortic valve replacement (TAVR), also known as transcatheter aortic valve implantation (TAVI), is a minimally invasive procedure designed to replace a narrowed or malfunctioning aortic valve, offering an alternative to traditional open-heart surgery for aortic valve stenosis patients. This innovative approach involves inserting a catheter through a small incision, usually in the groin, to precisely place a new aortic valve within the diseased valve. TAVR reduces recovery times and is suitable for patients who may not be candidates for traditional surgery.
Why is TAVR performed?
TAVR is mainly used for aortic valve stenosis, where the valve becomes thickened and narrow, limiting blood flow. It's an alternative to open-heart surgery, often leading to shorter hospital stays. Your doctor may recommend TAVR if you have
Severe Aortic Stenosis
This condition leads to symptoms like chest pain and shortness of breath.
A biological tissue aortic valve that isn't functioning properly
In some cases, a previously implanted biological tissue valve may need to be replaced.
Before the Procedure
Prior to the procedure, patients undergo a thorough evaluation to assess their overall health. This evaluation includes X-rays, CT scans, blood tests, and other diagnostic tests to evaluate the condition of the heart and lungs. An echocardiogram may be performed to assess the aortic valve's function.
Patients are required to inform their healthcare team about all medications they are taking, including prescription drugs, over-the-counter medicines, and supplements. The healthcare team will provide guidance on which medications to continue or discontinue leading up to the procedure.
Patients who smoke are strongly encouraged to quit smoking before the procedure, as smoking can increase the risk of complications during and after TAVR.
Typically, patients are instructed not to eat or drink anything for a specific period before the TAVR procedure, usually starting at midnight the night before.
During the TAVR Procedure
On the day of the procedure, patients are required to remove any jewelry or objects that could interfere with the TAVR process. They change into a hospital gown, empty their bladder, and are positioned on the operating table, lying on their back.
Anesthesia and Monitoring
Anesthesia is administered to ensure the patient's comfort during the procedure. Most often, sedation is used, but in some cases, general anesthesia may be required. The patient's heart rate, blood pressure, breathing, and blood oxygen levels are continuously monitored throughout the procedure.
The cardiologist typically accesses the circulatory system through a large artery, most commonly the femoral artery located in the groin area. Other access points, such as the neck or chest, may be used depending on the patient's anatomy and the specific TAVR device being used.
A catheter (a thin, flexible tube) is inserted through the chosen access point and carefully threaded through the patient's blood vessels, guided by X-ray or other imaging techniques. This catheter is directed toward the heart, specifically the location of the diseased aortic valve.
Once the catheter reaches the aortic valve, a replacement valve, which is typically made from biologic tissue is delivered through the catheter and positioned within or over the existing valve. There are two common types of TAVR devices: self-expanding valves and balloon-expandable valves.
In this method, the replacement valve is compressed within the catheter and expands automatically once it is positioned correctly within the old valve.
With this approach, a balloon located at the tip of the catheter is inflated to secure the new valve in place, and then the catheter is withdrawn.
After the new valve is placed, the medical team uses measurements and imaging to ensure its proper functioning. This step is crucial to confirm that the new valve is effectively restoring normal blood flow.
Once the replacement valve is securely positioned and confirmed to be functioning correctly, the catheter is removed. If the femoral artery was used for access, it is closed with a suture device that does not require any incision.
After the procedure, a transthoracic echocardiogram is often performed to assess the new valve's function and confirm that it is improving blood flow as expected.
After the TAVR Procedure
Following the TAVR procedure, patients are typically moved to the cardiac recovery floor for close monitoring during the initial stages of recovery.
Most patients can start walking and return to a regular diet shortly after the procedure. In many cases, patients are discharged from the hospital the day after TAVR.
Patients are prescribed medications, which may include blood thinners (anticoagulants) and antibiotics, as needed.
Regular follow-up appointments and imaging tests are essential to monitor the new valve's function and overall recovery progress.