TAVR

What is TAVR?

TAVR (transcatheter aortic valve replacement) is a medical procedure that replaces the aortic valve in your heart without open-heart surgery. Transcatheter aortic valve implantation (TAVI) is another name for TAVR.

Your aortic valve is an important part of your heart that handles blood flow as the blood leaves your heart. Your heart pumps oxygen-rich blood through that valve to your aorta and out to the rest of your body.

What does TAVR treat?

The most common reason to undergo transcatheter aortic valve replacement is aortic stenosis. This is the narrowing of your aortic valve or the area around it. Narrowing usually happens because of:

• Age-related wear and tear (especially if you’re over age 70) that can result in calcium buildup and/or thickening of the valve
• Other health conditions, like rheumatic heart disease or bicuspid aortic valve, that can make your valve decline faster

Narrowing of the valve limits how much blood flows out to the rest of your body, forcing your heart to pump harder to make up for it. That usually leads to long-term damage to your heart muscle and then heart failure.

What happens before a TAVR procedure?

Before you have a transcatheter aortic valve replacement (TAVR) procedure, you’ll likely have diagnostic tests. These help your provider measure blood flow inside your heart and get a preview of any potential problems they may need to fix. Tests include:

• Blood tests
• Echocardiogram
• Electrocardiogram (EKG)
• Computed tomography (CT) scan and/or heart magnetic resonance imaging (MRI)
• Cardiac catheterization to check your coronary arteries for blockages

After these tests, your healthcare provider will talk to you about what to expect during and after the procedure. They’ll also talk to you about the kind of anesthesia you’ll have during your TAVR procedure. And they can answer any other questions you might have.

You’ll need to stop eating and drinking four to six hours before a transcatheter aortic valve replacement procedure. Ask your provider if and when you need to stop taking certain medications before your procedure.

What happens during TAVR?

At the beginning of the procedure, you’ll receive sedation to keep you from feeling pain. You’ll also receive medicine to prevent blood clots.

During a transcatheter aortic valve replacement (TAVR) procedure, an interventional cardiologist will:

1. Make a small cut and insert a thin tube (catheter) into the femoral artery at your upper thigh (they can use a different entry point if they need to, but this one is the most common)
2. Thread the catheter up to your heart
3. Place the new valve inside your old aortic valve and expand it (the new valve will fit into place and stay there, while the old valve will stay behind the new one that pushed it aside)
4. Check for leaks and other issues
5. Remove the catheter device from your body
6. Stitch the entry point closed and bandage it

How long does TAVR take?

A transcatheter aortic valve replacement procedure typically takes about an hour or two from start to finish.

What happens after transcatheter aortic valve replacement?

After the TAVR procedure is over, a healthcare provider will stop the sedation so you can wake up. But they’ll keep you in bed for several hours (at the very least) to prevent bleeding. That’s because the entry point for the catheter was a major blood vessel, and they want to make sure the stitches are secure before you get up.

A provider may prescribe medicine to keep you from getting an infection or blood clot after the procedure.

What are the benefits of TAVR?

A transcatheter aortic valve replacement procedure has several advantages compared to surgery. Some advantages of TAVR include:

• Less invasive than surgery. Surgeons make large cuts and often have to lift or open your rib cage for heart surgery. TAVR involves one small cut, with no need to move any organs or ribs.
• Easier recovery. Limiting the number and size of the incisions also means there’s less healing for your body to do. That leads to less pain and an easier recovery.
• Shorter hospital stays. You may go home the same day or the next day after TAVR. It depends on what time you had your procedure, the severity of your case and your overall health.

Despite this, some people may still benefit from an aortic valve replacement surgery. Talk to your healthcare provider about whether TAVR or open-heart surgery is the right choice for you.

How successful is transcatheter aortic valve replacement?

The TAVR procedure is highly successful. Many people who need aortic valve replacement are “high-risk” because of the severity of the stenosis or other health conditions. That means they have a greater risk of complications or death from a major surgery like open-heart surgery. TAVR is an excellent alternative for them.

What are the risks or complications?

With advancements in valve and catheter technology, TAVR complications are infrequent. They include:

• A disruption in your heart’s electrical system that requires a pacemaker
• A leak around the outer edge of the new valve
• Stroke
• Bleeding
• Infection
• Heart attack
• Kidney, heart or blood vessel injury
• Low blood pressure
• Damage to the aorta
• A need for follow-up surgery
• Reactions to anesthesia or other medications from the procedure

Why some people shouldn’t have TAVR

Though it has many benefits, this procedure isn’t right for everyone. The most common reasons your provider may not recommend TAVR include:

• Heart attack within the last month
• Congenital heart defects (an issue present at birth) or similar problems
• A space that’s too short for the new valve to fit
• Severe weakening of certain parts of your heart
• Other heart valve problems like mitral regurgitation (leaky mitral valve)
• Recent stroke or transient ischemic attack (TIA)
• Severe kidney disease

Having a minimally invasive procedure has some advantages over a surgical procedure. But your provider will consider your specific situation to decide if this procedure is right for you.

What is the recovery time?

Most people who have transcatheter aortic valve replacement can leave the hospital within one day. Some may stay two days or more. The overall TAVR recovery time can vary depending on your case and your overall health.

Your healthcare provider is the best person to tell you how long your recovery is likely to take. In general, most people can return to most of their normal activities within days of the procedure. For some, it may take a little longer.

You’ll need to wait one week (or more, depending on where your provider put the catheter in) before moving heavy items or doing other physical activity. You can go back to work two weeks after TAVR and drive after one month of recovery. Complete recovery takes six to 10 weeks.

What follow-up care will I need?

You can expect to have checkups with a provider a month after the TAVR procedure and once a year after that. Your healthcare provider will tell you when you should see them for follow-up care. Regular follow-up care is vital to ensuring you have the best possible outcome. These visits can also include diagnostic tests to make sure the replacement valve is working well.

Your healthcare provider will likely refer you to a cardiac rehabilitation program. This is like a prescribed workout plan that involves a team of providers from several different fields. You’ll start this within several days of your TAVR procedure to increase your heart’s strength and endurance.

When should I call my healthcare provider?

After a transcatheter aortic valve replacement, contact your provider if you have:

• Fever
• Bleeding
• Pain or bruising at the entry site that gets worse
• Redness or discoloration
• Swelling
• Chest pain
• Dizziness
• Shortness of breath