Percutaneous Aortic Valve Replacement (TAVR)

Percutaneous Transcatheter Aortic Valve Replacement (TAVR) is a non-surgical, minimally invasive approach to replacing the aortic valve in the heart. Initially designed as an alternative for high-risk patients, meaning those too unwell for surgery, this method is now being increasingly utilized for low-risk patients as well.

What is TAVR?

Transcatheter Aortic Valve Replacement (TAVR) is a medical intervention that substitutes the aortic valve within the heart without the requirement for open cardiac surgery. Also referred to as transcatheter aortic valve implantation (TAVI), this procedure has gained widespread adoption, becoming the predominant method for aortic valve replacement. Current research indicates that TAVR is generally safer and yields outcomes comparable to or better than traditional aortic valve replacement surgery, contingent upon the procedure’s feasibility, given your health and personal circumstances.

Understanding the Necessity of TAVR: Why Choose this Procedure?

The human heart, with its intricate system of valves, orchestrates the sequential flow of blood. The aortic valve, positioned as the last in the series, propels blood from the heart to the rest of the body. When facing issues with the aortic valve, particularly aortic stenosis marked by narrowing or constriction, Transcatheter Aortic Valve Replacement (TAVR) emerges as a significant medical intervention, offering an alternative to traditional open-heart surgery.

Aortic stenosis, often attributed to calcium buildup on the valve and age-related wear and tear, becomes more prevalent, especially in individuals over 70. Other health conditions can also contribute to this narrowing. The consequence of such constriction is a limitation in the outflow of blood to the body, compelling the heart to work harder, potentially leading to long-term damage and, eventually, heart failure.

The primary indication for undergoing TAVR is the presence of aortic stenosis, particularly in those deemed “high-risk” individuals. High-risk status may result from the severity of stenosis or other concurrent health conditions, making major surgery a riskier option with potential complications or increased mortality. TAVR, being a less invasive alternative, becomes the preferred choice for such individuals.

In a significant development, the FDA extended its approval of TAVR in 2019 to include individuals at low risk for surgery-related complications. This expansion broadens the scope of the TAVR application, making it accessible to a broader demographic. Additionally, FDA approval has been granted for individuals who have previously undergone valve replacement surgery, highlighting the versatility and effectiveness of TAVR in various clinical scenarios.

The Stages of TAVR: Unveiling the Procedural Journey

Before the Procedure:

Before undergoing Transcatheter Aortic Valve Replacement (TAVR), a series of diagnostic tests are conducted to facilitate optimal planning for the procedure:

• Blood Tests:
  • Assess blood clotting, kidney function, and more.
• Echocardiogram:
  • Utilizes ultra-high-frequency sound waves for heart imaging.
  • It can be transthoracic (through the chest) or transesophageal (through the esophagus).
• Electrocardiogram (ECG or EKG):
  • Monitors the heart’s electrical activity using sensors on the chest.
• Other Imaging Tests:
  • Typically, it involves a computed tomography (CT) scan to create a three-dimensional image.
• Left Heart Catheterization:
  • Measures blood flow within the heart.
  • Offers an inside view of potential issues or alternative care needs.

After Testing:

Following pre-procedure testing, discussions with healthcare providers address expectations during and after the procedure. Considerations like general anesthesia or moderate sedation are based on individual circumstances.

During the Procedure:

TAVR procedures generally last about an hour and involve:

• Anesthesia:
  • Either general anesthesia or moderate sedation is administered.
  • General anesthesia induces sleep, utilizing a breathing machine (ventilator).
  • Moderate sedation offers a similar effect without the need for a ventilator.
• Catheter Insertion:
  • A catheter is inserted through a major blood vessel, often at the upper thigh.
  • Possible entry points include subclavian, trans-apical, or direct aortic approaches.
• Valve Placement:
  • The new valve is positioned inside the old one and expanded, securing its placement.
  • The catheter is removed, and the entry point is stitched and bandaged.
• Types of Valves:
  • FDA-approved TAVR valves include Edwards Lifesciences SAPIEN 3 and SAPIEN 3 Ultra (bovine tissue), Medtronic CoreValve Evolut R and Evolut PRO (porcine tissue), and Abbott’s Portico valve (porcine tissue).

Post-Procedure:

After TAVR, the cessation of anesthesia or sedation allows the patient to wake up. However, bed rest ensues to ensure the security of the catheter entry point stitches. Subsequently, patients may be referred to a cardiac rehabilitation program commencing within several days of the TAVR procedure. This program involves a structured workout plan overseen by a multidisciplinary team of medical professionals, aiming to enhance heart strength and endurance for optimal recovery and long-term well-being.

Understanding Recovery After TAVR:

Most individuals undergoing Transcatheter Aortic Valve Replacement (TAVR) are discharged within a day. The specific recovery timeline, however, hinges on individual cases and overall health. Your healthcare provider is the most reliable source to guide you on the anticipated recovery duration. Generally, many individuals can begin gradually reintegrating into their regular activities within a few days post-procedure. While most people resume their regular routines promptly, some may need a slightly extended recovery period.