TAVR

TAVR (transcatheter aortic valve replacement) is a minimally invasive procedure that replaces your aortic valve without open-heart surgery. An interventional cardiologist inserts a thin tube (catheter) into an artery, typically in your groin. They guide the catheter to your heart. The catheter delivers your new valve, placing it inside your old one.

Receiving a new aortic valve can help you feel better and live longer. It can also protect your heart. That’s because your heart pumps blood through your aortic valve and out to your entire body. If the valve isn’t working right, your heart is forced to work harder to push blood through. This extra workload can damage your heart over time, leading to heart failure.

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

What does TAVR treat?

TAVR treats 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 cause calcium buildup and/or thickening of the valve
• Rheumatic heart disease
• Bicuspid aortic valve

How should I prepare for this procedure?

You may need to fast (no food or drinks other than water) and stop taking certain medications before having TAVR. Your healthcare provider will tell you exactly what to do. Follow their guidance and ask if there’s anything you don’t understand.

Your provider may also run some tests, including blood and imaging tests, to help plan the procedure.

What happens during TAVR?

At the start of the procedure, you’ll receive sedation and/or anesthesia. You’ll also receive medicine to prevent blood clots.

To perform TAVR, an interventional cardiologist will:

1. Make a small cut in your upper thigh to access your femoral artery (they can use a different entry point if needed, but this one is the most common)
2. Insert a catheter into the artery
3. Thread the catheter up to your heart
4. Place the new valve inside your old aortic valve and expand it (the new valve fits into place with the old one behind it)
5. Check for leaks and other issues
6. Remove the catheter from your body
7. Stitch the entry point closed and bandage it

TAVR typically takes about an hour or two from start to finish.

What are the benefits of TAVR?

Transcatheter aortic valve replacement has several advantages over surgery. These include:

• Less invasive: 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 means there’s less healing for your body to do. That leads to less pain and an easier recovery.
• Shorter hospital stay: You may go home the same day or the next day after TAVR. It depends on the time of your procedure, the severity of your case and your overall health.

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

Despite this, some people may still benefit from an aortic valve replacement surgery. Talk to your healthcare provider about what’s right for you.

What are the risks or complications?

With advancements in valve and catheter technology, TAVR complications don’t happen often. But when problems do arise, they may 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

TAVR has many benefits. But it’s not right for everyone. The most common reasons your provider may not recommend TAVR include:

• Heart attack within the last month
• Congenital heart defects (issues present at birth)
• 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 happens after the TAVR procedure?

After you wake up from surgery, you’ll need to stay in bed for at least several hours. This is to prevent bleeding from the spot where the catheter went in. Your care team will 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 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. It depends on how your procedure went and your overall health.

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

You’ll need to wait at least one week before moving heavy items or doing other physical activity. You can typically go back to work two weeks after TAVR and drive after one month. Complete recovery takes six to 10 weeks.

What follow-up care will I need?

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

Your healthcare provider will tell you when you should see them for follow-up care. You can expect a checkup a month after your TAVR procedure and then once a year after that. Regular follow-up care is vital. It allows your provider to check your heart and see how you’re feeling. They may also run tests to make sure your new valve is working well.

When should I call my healthcare provider?

After TAVR, 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