Transcatheter Aortic Valve Replacement (TAVR)
What Is TAVR?
Transcatheter aortic valve replacement (TAVR) is a minimally invasive, nonsurgical approach to treating patients with severe aortic stenosis. Aortic stenosis is a progressive disease that, if left untreated, can lead to heart failure, chest pain, fainting, arrhythmia, and sudden cardiac death.
In the past, patients with severe aortic stenosis had very limited options. The only way to replace the aortic valve was surgically, through open heart surgery and general anesthesia. The risks of open heart surgery as well as increased recovery time make TAVR a much more ideal option for valve replacement.
Traditionally, TAVR utilizes a small puncture through the femoral artery in the groin to obtain access to the valve using standard cardiac catheterization. Patients are typically not placed under general anesthesia and are carefully monitored only with moderate sedation administered via an intravenous line. Hence, breathing tubes and endotracheal intubation are generally not necessary. Furthermore, numbing medication is administered in the groin area as well to minimize discomfort.
Next, a bioprosthetic valve is carefully positioned within the diseased native valve and deployed. The native aortic valve is not “removed” from the body; however, it is completely distorted in an outward fashion during the procedure to make room for the healthy, bioprosthetic valve. In most cases, patients are awake, alert, and converse immediately following the procedure. In addition, walking the same day of the procedure is encouraged, and most patients are discharged the following day!
Since FDA approval in 2011, TAVR has completely changed the paradigm for treating patients with aortic stenosis. TAVR was previously available only for patients who were deemed too “high risk” for open heart surgery; however, it is now approved for both high- and intermediate-risk patients. Clinical trials are currently underway for low-risk patients as well.
What Is Aortic Stenosis?
The aortic valve separates the left ventricle, or main pumping chamber of the heart, from the aorta, which sends blood to the entire body for circulation. Aortic stenosis occurs when the valve becomes severely calcified or thickened, which prevents the valve from fully opening and disrupts the natural flow of blood from the heart. This can significantly impair the forward flow of blood from reaching the major vessels and critical organs throughout the body. For patients who suffer from aortic stenosis, the heart works much harder to pump blood throughout the body and has an overall detrimental effect on circulation and heart health.
Patients with severe aortic stenosis who experience any of the following symptoms should seek urgent medical attention with a cardiologist:
- Chest pain
- Shortness of breath
- Fatigue
- Heart palpitations
- Dizziness or fainting
Before the Procedure
Preparing for TAVR
In order to prepare for your TAVR procedure, you need to first discuss with your doctor any current medications you are on and ask before attempting to take anything new or stop taking medications. Your doctor may ask that you stop taking such medications, such as those that control your heart rate. Do not discontinue any of your medications without first talking to your healthcare provider. For those who have diabetes, ask the nurse how to adjust your diabetes medications or insulin.
Always ask your cardiologist which medications you should stop taking and when to stop taking them. You should also inquire about your diet before and after your procedure. Take medications with only small sips of water if you must take them before your surgery.
Risks
What Are the Possible Risks of the Procedure?
TAVR is not excluded from carrying potential risks. Some of the risks of the TAVR procedure can include blood vessel complications, bleeding, infection at the access point, issues with the replacement valve such as slipping or leaking, heart rhythm abnormalities requiring permanent pacemaker, heart attack, stroke, kidney disease, and death.
What to Bring
On the day of your TAVR procedure, bring a change of clean, easy-to-fold clothing, personal care items (toothbrush, comb, etc.), and items you need to help you relax, such as a book, tablet, or smartphone. Avoid wearing your contact lenses, dentures, makeup, and nail polish on this day. Do not bring jewelry or other such valuable items with or on you going into your surgery. It is always best to leave items such as these at home so they are not lost.
After the Procedure
Within hours, patients who have had the TAVR procedure are up and walking on the same day of the procedure.
The access site is monitored for possible infection or other bleeding complications. Patients are typically discharged the day after TAVR; however, some may need to stay in the hospital for a few days following to make sure the procedure has gone according to plan. You can learn more about the recovery from TAVR procedure on our blog.
Activities Guideline
Following your procedure, you may want to take part in some low-impact activities. Some low-impact exercises include walking, cycling, utilizing the Stairmaster machine, elliptical, swimming or water aerobics, strength training, yoga, and Pilates. Be sure to ask your doctor about making changes to your diet and exercise.
Medication
Your doctor may prescribe blood thinning medications after your procedure is complete. Be sure to ask your doctor about current and new medications following your TAVR procedure.
Follow-Up
You should check in with your cardiologist often enough so that they can track your progress. Use your in-office visits to ask questions you may have after your procedure.
Importance of a Heart-Healthy Lifestyle
Following your TAVR procedure, you will be encouraged to continue your health journey with a balanced diet and exercise program. These things in conjunction with your newly repaired aortic valve can better assure that you will live a long and healthy life.