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.