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Transcatheter aortic valve replacement (TAVR)

Definition

Approved by the U.S. and Food Drug Administration in November 2011, transcatheter aortic valve replacement (TAVR) is a new, minimally invasive aortic valve replacement technique. Aortic stenosis, a severe narrowing of the aortic valve, has traditionally been treated with open surgical replacement of the damaged valve; however, due to a variety of factors, some patients are not candidates for open chest surgery. The TAVR procedure is a minimally invasive treatment that improves blood flow by using an artificial valve to take over the work of a diseased aortic valve. The artificial valve – framed by a stent and wrapped around a balloon – is transported up to the aortic valve via a larger catheter in the leg. The new valve is then anchored into position inside the diseased valve by inflation of a balloon. Placement of the stent is monitored with X-ray and ultrasound imaging.

Alternative Names

Percutaneous minimally invasive valve procedure

Why the Procedure Is Performed

TAVR treats aortic stenosis, a condition in which the aortic valve narrows and over time requires the heart to work harder as it pushes blood through the narrowing valve. The extra strain on the left ventricle to pump blood can lead to heart failure, a heart attack or sudden death. The condition is typically followed conservatively over time until intervention is needed.

Risks

Risks for any surgery include:

  • heart rhythm problems requiring pacemaker placement
  • Breathing problems
  • Minor Infection, including in the lungs, urinary tract, and chest
  • Minor Blood loss

Possible risks from undergoing TAVR include:

Before the Procedure

Several sophisticated tests will help determine candidacy for the procedure, including CT scanning, echocardiography (ultrasound of the heart) and possibly cardiac catheterization to evaluate the coronary blood flow.

After the Procedure

Most patients are in the intensive care unit for close observation for a couple of days and then transferred to the regular surgical ward for a couple additional days. Often, patients are able to return directly home with family, but some may benefit from a brief stay in a rehabilitation and therapy center depending on his or her physical status prior to surgery. The physical therapy team will be closely involved in making recommendations.

Outlook

Overall, prognosis for patients following TAVR is excellent. Current evidence suggests that this new technology restores the normal pressures and flows to the heart and is durable as a replacement for the native valve. Patients should expect to enjoy excellent longevity and quality of life following their successful procedure, with significant improvements in the limitations experienced prior to TAVR.