Aortic Valve Replacement or TAVR

Aortic valve replacement or transcatheter aortic valve replacement (TAVR) is a minimally invasive cardiac procedure to replace a narrowed aortic valve in the heart with a synthetic (man-made) valve. The narrowing of the aortic valve is known as aortic valve stenosis and is usually due to calcium buildup on the valve and age-related wear and tear, especially for those over the age of 70. It can also occur due to other health conditions.

A traditional aortic valve replacement surgery involves opening up the chest to access the narrowed valve. TAVR is a less invasive procedure that replaces the narrowed valve without an open-heart surgery. It involves inserting a new valve within the narrowed aortic valve without removing the old, damaged valve and restoring normal heart function. Transcatheter aortic valve replacement is also known as transcatheter aortic valve implantation (TAVI).

Indications 

Aortic valve replacement or TAVR is commonly recommended for patients with severe aortic stenosis. Aortic stenosis, also known as aortic valve stenosis, is a condition characterized by an abnormal narrowing of the aortic valve at the junction between the heart and the aorta, thereby restricting blood flow to the aorta and the rest of the body. A narrowed aortic valve has to work harder to pump blood through the small valve opening to the rest of the body. This usually leads to long-term damage to your heart muscle and eventually heart failure. TAVR is a treatment alternative for patients with aortic stenosis who cannot have a major surgery, as well as for people at moderate risk from surgery who prefer a minimally invasive alternative.

Preparation

Preoperative preparation for aortic valve replacement or TAVR surgery may involve the following:

• Routine diagnostic tests such as blood work, urinalysis, electrocardiogram (ECG), and chest x-ray
• Informing your doctor of any allergies to medications, anesthesia, or latex
• Providing your physician with a list of medications and supplements you are taking
• Disclosing any recent illnesses or other medical conditions you may have
• Abstaining from smoking for at least two weeks prior to surgery as smoking can contribute to blood clotting and breathing issues
• Abstaining from food or drink for about 8 hours prior to the surgery

Surgical procedure

Aortic valve replacement or TAVR is usually performed under moderate sedation or general anesthesia. At the start of the procedure, your surgeon will make a small incision in one of three normally used access routes: a small cut in the groin, the neck, or a space between your ribs. Your surgeon will insert a thin, flexible tube called a catheter containing a new, collapsible aortic valve with a deflated balloon through a small incision, most commonly in the groin (femoral artery). Using ultrasound and chest x-rays, the catheter is guided through the femoral artery and up into your aortic valve in the heart. Once the new valve is in the correct position, it is implanted and expanded by inflating a small balloon. The new valve starts to control blood flow immediately and restores normal heart function. The catheter is withdrawn, and the incision is closed with a suture device.

Postoperative care

After the surgery, you will be transferred to an observation room where you will be monitored by medical staff for several hours for any signs of complications and you will be discharged within a day or two. You may experience pain, swelling, or discomfort at the catheter insertion site. Medications are provided as needed to address these. Instructions on incision site care and bathing will be provided to help keep the wound clean and dry. You should avoid strenuous exercise or activity for one to two weeks to allow the incision site to heal. Also, your physician will likely refer you to a cardiac rehabilitation program to help you increase your heart’s strength and endurance and recover from the surgery.

Risks and Complications

Aortic valve replacement or TAVR is a safe procedure. However, as with any surgery, some risks and complications may occur, such as:

• Damage to arteries
• Bleeding
• Stroke
• Heart attack
• Kidney injury
• Heart failure
• Need for a pacemaker
• Death

Summary

Aortic valve replacement or transcatheter aortic valve replacement (TAVR) is a minimally invasive method to replace an aortic valve in your heart that has narrowed and does not open fully. The procedure is typically performed through a small incision in the groin and involves using a catheter to implant a new valve to replace the damaged one.