Transcatheter aortic valve replacement (TAVR)

Overview

Transcatheter aortic valve replacement (TAVR) is a minimally invasive heart procedure to replace a narrowed aortic valve that fails to open properly (aortic valve stenosis). Transcatheter aortic valve replacement is sometimes called transcatheter aortic valve implantation (TAVI).

TAVR may be an option for people who are at intermediate or high risk of complications from surgical aortic valve replacement (open-heart surgery). The decision to treat aortic stenosis with TAVR is made after you consult with a team of heart and heart surgery specialists, who work together to determine the best treatment option for you.

TAVR can relieve the signs and symptoms of aortic valve stenosis and may improve survival in people who have severe symptoms.

Why it's done

Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure to replace the aortic valve in people with aortic valve stenosis.

Aortic valve stenosis — or aortic stenosis — occurs when the heart's aortic valve thickens and calcifies, preventing the valve from opening fully, which limits blood flow from your heart to the rest of your body. Aortic stenosis can cause chest pain, fainting, fatigue, leg swelling and shortness of breath. It may also lead to heart failure and sudden cardiac death.

Who benefits most from TAVR

TAVR may be an option if:

• You have aortic stenosis that causes signs and symptoms.
• You have an intermediate or high risk of complications from surgical aortic valve replacement. Kidney and lung disease can increase your risk of complications during surgical aortic valve replacement.
• You have an existing biological tissue valve but it isn't working well anymore.

Risks

All medical procedures come with some type of risk. Risks of transcatheter aortic valve replacement (TAVR) may include:

• Bleeding
• Blood vessel complications
• Problems with the replacement valve, such as the valve slipping out of place or leaking
• Stroke
• Heart rhythm problems (arrhythmias) and the need for pacemaker implantation
• Kidney disease
• Heart attack
• Infection
• Death

How you prepare

Your treatment team will give you instructions on how to prepare for your transcatheter aortic valve replacement (TAVR) procedure. Talk to your doctor if you have any questions about the procedure.

You may need to have your hair shaved off at the location of your body where the procedure will take place.

Food and medications

Talk to your doctor about:

• When you can take your regular medications and whether you can take them before your procedure
• When you should stop eating or drinking before the procedure
• Any drug allergies that you have

Clothing and personal items

Your treatment team may recommend that you bring several items to the hospital, including:

• A list of all the medications you take, including those bought without prescriptions
• Eyeglasses, hearing aids or dentures
• Personal care items, such as a brush, comb, toothbrush and shaving equipment
• Loose-fitting, comfortable clothing
• Items that may help you relax, such as portable music players or books

During your procedure, avoid wearing:

• Jewelry
• Eyeglasses
• Contact lenses
• Dentures
• Nail polish

What you can expect

Transcatheter aortic valve replacement (TAVR) involves replacing your damaged aortic valve with one made from cow or pig heart tissue, also called a biological tissue valve. In some cases, a TAVR biological tissue valve may be placed into an existing biological tissue valve that is no longer working.

Before the procedure

You'll be evaluated to make sure you don't have any risk factors that may affect you during the TAVR procedure.

You may be given a medication to reduce the risk of infection prior to your procedure.

During the procedure

You will receive sedation or general anesthesia during the TAVR procedure. A treatment team member will give you medication through an IV  to prevent blood clots.

Your treatment team will monitor your blood pressure, heart function and rhythm, and watch for any changes, which can be managed with treatments as needed during the procedure.

To perform TAVR, the doctor may access your heart through a blood vessel in your leg or through a tiny incision in your chest. The doctor may sometimes use other approaches to access your heart. A hollow tube (catheter) is inserted through the access point. Your doctor uses advanced imaging techniques to guide the catheter through your blood vessels, to your heart and into your aortic valve.

Once the new valve is positioned, a balloon on the catheter's tip is inflated to expand the replacement valve into the appropriate position. Some valves can expand without the use of a balloon.

When your doctor is certain the valve is securely in place, the catheter is removed.

After the procedure

You may spend the night in the intensive care unit for monitoring after your procedure. Generally you'll spend about two to five days recovering in the hospital.

You'll need regular follow-up appointments with your doctor after TAVR. Let your doctor know if you have any new or worsening signs or symptoms.

You may need to take certain medications after your procedure. For example, you'll need to take blood-thinning medications to prevent future blood clots. Your doctor will discuss with you how long you may need to take these medications. Always take your medications as prescribed.

Artificial heart valves, including a transcatheter aortic valve, can become infected with bacteria. Most bacteria that cause heart valve infections come from the bacteria in the mouth. Excellent dental hygiene, including routine dental cleanings, can help prevent these infections. Your doctor will recommend that you take medications before certain dental procedures to prevent infections.

Your doctor may recommend that you make healthy lifestyle changes, such as eating a heart-healthy diet, exercising regularly, maintaining a healthy weight and avoiding smoking.

Results

Transcatheter aortic valve replacement (TAVR) may relieve the signs and symptoms of aortic valve stenosis and improve your overall health and quality of life. TAVR can also reduce the risk of death.