Transcatheter Aortic Valve Replacement

What is transcatheter aortic valve replacement?

Transcatheter aortic valve replacement (TAVR) is a medical procedure that replaces the aortic valve in your heart without open-heart surgery. This minimally invasive procedure is now the most common way to replace an aortic valve.

Your aortic valve is the last of your heart’s four valves to handle blood flow. Your heart pumps oxygen-rich blood through that valve, to your aorta and out to the rest of your body.

Research shows that TAVR is usually safer and has either similar or better outcomes than surgical aortic valve replacement (SAVR). Replacement valves use cow or pig tissue in a metal frame.

Transcatheter aortic valve implantation (TAVI) is another name for this procedure.

What does transcatheter aortic valve replacement 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 comes from:

• 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 speed up degeneration of the valve.

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.

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.

People at other risk levels can have a transcatheter aortic valve replacement, too. In 2019, the U.S. Food and Drug Administration also approved transcatheter aortic valve replacement for people who are at a low risk for complications from surgery. TAVR also has FDA approval for people who previously had valve replacement surgery.

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.

How common is transcatheter aortic valve replacement?

Providers perform more than 72,000 transcatheter aortic valve replacement procedures a year in the United States.

How should I prepare for transcatheter aortic valve replacement?

Before you undergo a transcatheter aortic valve replacement procedure, you’ll likely have the following diagnostic tests. They include:

• Blood tests.
• Echocardiogram.
• Electrocardiogram (EKG).
• Computed tomography (CT) scan and/or heart magnetic resonance imaging (MRI).
• Cardiac catheterization of the left side of your heart. Providers use this to measure blood flow inside your heart. They also can preview any potential problems they may need to fix.

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 transcatheter aortic valve replacement?

At the beginning of the procedure, you’ll receive either moderate sedation (most common) or general anesthesia (less common). Both use medicine to keep you from feeling pain, but the effect of moderate sedation isn’t as strong. Also, with moderate sedation, you don’t need a tube in your throat for a breathing machine (ventilator). For general anesthesia, a provider places a tube in your throat and connects it to a breathing machine. A provider removes the tube once the procedure is over.

You’ll also receive medicine to prevent blood clots.

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

1. Make a small cut (incision) 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 should fit into place and stay there. 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 transcatheter aortic valve replacement 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 provider will stop the anesthesia or 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 transcatheter aortic valve replacement?

A transcatheter aortic valve replacement procedure has several advantages compared to surgery. This is why it’s now the most common method for replacing aortic valves. Some of those advantages include:

• Less invasive than surgery. Most surgeries on your heart involve larger incisions in your chest. Surgeons also often have to lift — or even crack and spread open — your rib cage to do heart surgery. TAVR involves one small incision only, with no need to move any of your internal 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. Heart surgeries usually involve a hospital stay that lasts several days. Your provider may send you home the same day or the next day after transcatheter aortic valve replacement. That depends on what time you had your procedure, the severity of your case and your overall health.

How successful is transcatheter aortic valve replacement?

The transcatheter aortic valve replacement procedure has a 90% success rate. Early on, clinical studies and trials found that TAVR was more likely to be successful and less likely to cause death or major complications among people with higher risks for complications from surgery. Later trials on low-risk people had similar results, finding that people who underwent transcatheter aortic valve replacement had:

• Higher one-year survival rates.
• Lower rates of stroke.
• Lower rates of rehospitalization within a year.

What are the risks or complications of transcatheter aortic valve replacement?

With advancements in valve and catheter technology, complications are rare. 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 you might receive during this procedure.

Reasons why some people shouldn’t have TAVR

Though it has many benefits, this procedure isn’t right for everyone. The most common reasons 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.

What is the transcatheter aortic valve replacement 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 transcatheter aortic valve replacement recovery time can vary depending on your case and your overall health.

You can expect to have checkups with a provider a month after the procedure and once a year after that. Your healthcare provider is the best person to tell you how long your recovery is likely to take. In general, most people can start resuming 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.

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.

If you’re feeling depressed after your procedure, that’ll likely get better with time. Meanwhile, reach out to a counselor or friend for support.

When should I call my healthcare provider?

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

• Fever.
• Pain or bruising at the entry site that gets worse instead of staying the same or getting better.
• Redness or discoloration.
• Swelling.
• Chest pain.
• Dizziness.
• Shortness of breath.

Your healthcare provider will tell you when you should see them for follow-up care. If you have a heart valve replacement (and are likely taking blood thinners), 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.

A note from Cleveland Clinic

You may not like thinking about someone putting a new valve into your heart, but you’re not the first. Thousands of people have had a transcatheter aortic valve replacement. It offers many advantages over open-heart surgery, regardless of your surgical risk level. You can give yourself some peace of mind by choosing a provider with a lot of experience performing this procedure.