What happens before the procedure?
It will take about an hour to get you ready for the actual procedure. The procedure itself takes about an hour. During that time, you will have a pacing wire in your heart to let the doctor control your heart rate while the valve is put in place. If there are concerns about your heart rhythm, the wire will stay in place for a day or longer.
What happens during the procedure?
Your aortic valve will be replaced with a valve made from animal tissue (biological). The tissue is supported with a metal frame. Despite the metal frame, having the valve will not require you to take blood thinners. But, if you are already taking a blood thinner, you will need to keep taking it.
The new valve is put in place using a catheter. This is a long thin tube that is guided to the diseased aortic valve. The valve is sent through the catheter and then secured in place.
Once the valve is in place, your doctor will make sure it is working. Then, the catheter is removed and your incision will be closed.
What are the types of TAVR approaches?
There are several ways to implant the new valve. Your doctor will decide which approach is the best for you and may mention approaches other than those described below.
A transfemoral approach is done through a small incision in the skin at the top of your thigh (groin), and the catheter goes into your femoral artery. The doctor uses a dye and a specialized X-ray (fluoroscopy) to guide the new valve through the catheter to the diseased valve. The procedure is done using conscious sedation (“twilight sleep”).This is the most commonly used approach. About 90% of TAVR patients have a transfemoral procedure.
The transapical approach is done through a 4-inch incision between the ribs. The new valve is inserted through the incision and placed directly inside the diseased aortic valve. The doctor uses a dye and a specialized X-ray (fluoroscopy) to guide the new valve to the diseased valve. The procedure is done using general anesthesia (while you are “asleep”).
Direct Aortic Approach
The direct aortic approach is done through a J-shaped incision at the top of the breastbone (sternum). The catheter is guided into the aorta and the valve is put in place. The procedure is done using general anesthesia (while you are “asleep”).
The subclavian approach is done through a small incision near your shoulder, and the catheter goes into your subclavian artery. The new valve is guided through the artery into the aorta and put in place. This procedure may be done with general anesthesia or conscious sedation (“twilight sleep”).
What are the types of TAVR valves?
The Medtronic CoreValve and Edwards’ SAPIEN are the most commonly used TAVR prosthetic valves. But, your doctor may talk to you about other types of valves that may be right for you.
Image used with permission by Medtronic. ©2014
Images used with permission by Edwards Lifesciences. ©2014
To help prevent cerebrovascular events (stroke), a potential risk during TAVR, the Cleveland Clinic Structural Heart team uses the Sentinel Cerebral Protection System in appropriately selected patients. The team has been using the device since 2015 as part of the device’s pivotal trial which was led by Dr. Samir Kapadia. This Sentinel system was approved by the FDA in June 2017.
Valve in Valve TAVR
Patients who had SAVR or surgical mitral valve replacement may develop valve degeneration 10 to 20 years after surgery. These patients can have a repeat surgery or a “valve- in- valve” (ViV) procedure. A valve-in-valve procedure involves placing the new valve (aortic or mitral) into the old one using a transcatheter approach. You may be able to have a valve-in-valve procedure if:
- Your old valve was replaced with a prior bioprosthetic valve
- Your old valve opening is the right size to support a transcatheter valve
- You are considered high risk for traditional heart surgery
- You don’t have other valve conditions that would be best corrected with traditional heat surgery
What happens after the procedure?
Many patients who have TAVR are able to go home the day of the procedure or the next day. If you have your TAVR procedure through a chest incision, you will stay in the hospital for several days after your procedure.
You will be given information about care after your TAVR while you are in the hospital and provided with a phone number to call if you have any questions after you leave the hospital.
It is very important to make sure you follow-up with your doctor after the TAVR procedure. You will need to see your cardiologist and have an echo within one month of the procedure. You will need another appointment with your cardiologist 6 months after the procedure, and at 1 year after you get your new valve (or sooner, depending on your cardiologist’s recommendation).