What is Transcatheter Aortic Valve Replacement (TAVR)? Purpose, Procedure & Results

Transcatheter aortic valve replacement (TAVR) is a minimally invasive heart procedure that replaces a damaged aortic valve without open-heart surgery. Instead of making a large chest incision, your doctor inserts a new valve through a small catheter, usually through an artery in your leg. This innovative approach helps people with severe aortic valve disease who may be too high-risk for traditional surgery.

What is TAVR?

TAVR is a groundbreaking procedure that gives your heart a new aortic valve through a much gentler approach than traditional surgery. Your aortic valve controls blood flow from your heart to the rest of your body, and when it becomes severely narrowed or damaged, your heart has to work much harder.

During TAVR, a specialized team guides a collapsed replacement valve through your blood vessels to reach your heart. Once in position, the new valve expands and takes over the job of your damaged valve. The procedure typically takes 1-3 hours and is performed in a specialized cardiac catheterization lab.

The beauty of TAVR lies in its minimal invasiveness. Most people recover faster than they would from open-heart surgery, often going home within 1-3 days. Your original valve stays in place, and the new valve is positioned inside it.

Why is TAVR done?

TAVR is primarily performed to treat severe aortic stenosis, a condition where your aortic valve becomes too narrow to allow proper blood flow. This happens when the valve leaflets become thick, stiff, or calcified over time, making it difficult for your heart to pump blood effectively.

Your doctor might recommend TAVR if you have symptoms like shortness of breath, chest pain, dizziness, or fainting spells that interfere with your daily activities. These symptoms occur because your heart is working overtime to push blood through the narrowed valve.

TAVR is especially beneficial for people who are considered high-risk or intermediate-risk for traditional open-heart surgery. This includes older adults, people with multiple health conditions, or those with previous heart surgeries. However, TAVR is increasingly being offered to lower-risk patients as well.

Some people with severe aortic regurgitation (where the valve leaks backward) may also be candidates for TAVR, though this is less common. Your heart team will carefully evaluate your specific situation to determine if TAVR is the right choice for you.

What is the procedure for TAVR?

The TAVR procedure begins with you receiving conscious sedation or general anesthesia, depending on your specific case and your doctor's preference. You'll be monitored continuously throughout the procedure with advanced imaging equipment.

Here's what typically happens during your TAVR procedure:

1. Your doctor makes a small puncture in an artery, usually in your groin, though sometimes they may use an artery in your chest, arm, or neck
2. A thin, flexible catheter is carefully guided through your blood vessels to reach your heart
3. The collapsed replacement valve, mounted on a balloon or self-expanding frame, travels through the catheter
4. Using precise imaging guidance, the new valve is positioned exactly where your damaged valve sits
5. The valve is expanded, either by inflating a balloon or allowing it to self-expand
6. Your doctor checks the valve's position and function using imaging and may make adjustments if needed
7. The catheter is removed, and the small access site is closed

The entire procedure usually takes 1-3 hours, though preparation and recovery time in the procedure room may extend this. Most people are awake during the procedure and can even watch parts of it on the monitor if they're interested.

Your heart team typically includes a cardiologist, cardiac surgeon, anesthesiologist, and specialized nurses working together. This collaborative approach ensures you receive the safest, most effective care possible.

How to prepare for your TAVR?

Preparing for TAVR involves several important steps that help ensure the best possible outcome. Your medical team will guide you through each step, but understanding what to expect can help you feel more confident and prepared.

In the weeks before your procedure, you'll undergo comprehensive testing to map out your heart's anatomy and confirm TAVR is right for you. This typically includes a CT scan of your chest, heart catheterization, echocardiogram, and blood tests.

Your preparation checklist will likely include these important steps:

• Stopping certain medications as directed by your doctor, particularly blood thinners
• Arranging for someone to drive you home and stay with you for the first day
• Following fasting instructions, usually no food or drink after midnight before your procedure
• Showering with antibacterial soap the night before and morning of your procedure
• Wearing comfortable, loose-fitting clothes and leaving jewelry at home
• Bringing a list of all your medications and any advance directives

Don't hesitate to ask your care team about any concerns or questions you have. They want you to feel as prepared and comfortable as possible. If you develop any signs of illness like fever, cough, or cold symptoms before your procedure, contact your doctor immediately.

How to read your TAVR results?

Understanding your TAVR results focuses on how well your new valve is working and how your heart is responding to the improved blood flow. Your doctor will use several different measurements and tests to evaluate your valve's performance.

Immediately after TAVR, your medical team will check your valve function using echocardiography and other imaging. They're looking for proper valve opening and closing, minimal leakage, and good blood flow patterns. Most people see immediate improvement in their heart's ability to pump blood.

Key measurements your doctor will monitor include:

• Valve gradient (pressure difference across the valve) - should be significantly lower than before
• Valve area - should be much larger, allowing better blood flow
• Ejection fraction - measures how well your heart pumps blood
• Presence and severity of any valve leakage
• Overall heart function and rhythm

Your symptoms are equally important indicators of success. Many people notice improvements in breathing, energy levels, and ability to be active within days to weeks after the procedure. However, it can take several months for your heart to fully recover and for you to experience maximum benefits.

Follow-up appointments typically occur at 1 month, 6 months, and then annually. During these visits, your doctor will perform echocardiograms and other tests to ensure your valve continues working properly and your heart health is stable.

How to optimize your recovery after TAVR?

Recovery after TAVR is generally faster and less intensive than traditional open-heart surgery, but taking proper care of yourself is still crucial for the best outcome. Most people can return to normal activities within a few weeks, though everyone's timeline is different.

In the first few days after your procedure, you'll focus on rest and gradual activity increase. Your care team will guide you on when it's safe to shower, drive, and return to work. Many people feel significantly better within the first week as their heart adjusts to improved blood flow.

Important aspects of your recovery include:

• Taking prescribed medications exactly as directed, including blood thinners
• Gradually increasing physical activity as recommended by your doctor
• Attending all follow-up appointments for monitoring
• Watching for signs of complications like fever, unusual bleeding, or worsening symptoms
• Maintaining heart-healthy lifestyle habits like eating well and staying active
• Avoiding heavy lifting (usually more than 10 pounds) for the first few weeks

Cardiac rehabilitation is often recommended after TAVR to help you safely rebuild your strength and endurance. This supervised exercise program can significantly improve your recovery and long-term heart health.

Most people find their quality of life improves dramatically after TAVR. You may notice you can climb stairs more easily, walk longer distances, and feel less short of breath during daily activities.

What is the best TAVR valve type?

The best TAVR valve for you depends on your specific anatomy, health conditions, and lifestyle factors. There are several excellent valve options available, and your heart team will carefully select the most appropriate one for your situation.

Currently, there are two main types of TAVR valves: balloon-expandable and self-expanding. Balloon-expandable valves are precisely positioned and then expanded using a balloon, while self-expanding valves automatically open once released from their delivery system.

Factors that influence valve selection include:

• Your aortic valve anatomy and size
• The shape and calcification pattern of your valve
• Your overall health and other medical conditions
• Previous heart procedures or surgeries
• Your age and expected longevity
• Risk factors for complications

All modern TAVR valves are designed to last many years, though we're still learning about their very long-term durability. The valves are made from either bovine (cow) or porcine (pig) tissue, similar to surgical valves, and are well-tolerated by most people.

Your doctor will discuss the specific valve they recommend and explain why it's the best choice for your situation. The most important thing is that the valve is properly sized and positioned for your anatomy.

What are the risk factors for TAVR complications?

While TAVR is generally very safe, understanding the risk factors can help you and your doctor make the best decisions about your care. Most people do very well with TAVR, but certain conditions can increase the likelihood of complications.

Age alone is not a risk factor, but other health conditions that often come with aging can affect your TAVR outcome. Your heart team will carefully evaluate all these factors before recommending the procedure.

Common risk factors that may increase complications include:

• Severe kidney disease or kidney failure
• Previous stroke or significant vascular disease
• Severe lung disease or breathing problems
• Bleeding disorders or need for blood thinners
• Diabetes with complications
• Severely weakened heart muscle
• Previous heart surgery or procedures
• Extremely calcified or irregular valve anatomy

Less common but more serious risk factors include severe liver disease, active infection, and certain types of heart rhythm problems. Your doctor will also consider your overall frailty and ability to tolerate the procedure.

Even if you have risk factors, TAVR may still be your best option. Your heart team will work with you to minimize risks and optimize your outcome. They may recommend additional treatments or precautions to improve your safety.

Is it better to have TAVR or surgical valve replacement?

The choice between TAVR and surgical aortic valve replacement depends on many individual factors, and both procedures can be excellent options for treating severe aortic valve disease. Your heart team will help you understand which approach is best for your specific situation.

TAVR offers several advantages, including faster recovery, no need for a chest incision, shorter hospital stays, and lower immediate procedural risks for many patients. Most people can return to normal activities within weeks rather than months.

However, surgical valve replacement may be better in certain situations:

• If you're young and likely to need the valve to last many decades
• If you have other heart problems that need surgical repair at the same time
• If your valve anatomy isn't suitable for TAVR
• If you have certain types of valve disease beyond aortic stenosis
• If you have active infection in your heart

Recent studies show that TAVR outcomes are excellent even in younger, lower-risk patients. Many people who were previously considered only for surgery are now good candidates for TAVR.

Your heart team will present all your options and explain the benefits and risks of each approach. They'll consider your age, overall health, valve anatomy, lifestyle, and personal preferences to help you make the best decision.

What are the possible complications of TAVR?

While TAVR is generally very safe, it's important to understand potential complications so you can make an informed decision and know what to watch for after your procedure. Most people have no complications, but being aware helps you recognize when to seek medical attention.

Serious complications are uncommon but can occur. Your medical team takes many precautions to prevent these issues and is prepared to manage them if they arise.

Potential complications during or shortly after TAVR include:

• Bleeding at the access site or internally
• Stroke or temporary neurological symptoms
• Heart rhythm problems requiring a pacemaker
• Valve leakage around the new valve
• Kidney problems from contrast dye
• Blood vessel injury or complications
• Heart attack or heart muscle damage
• Infection at the access site

Less common but serious complications include valve migration, coronary artery blockage, or need for emergency surgery. Your risk for these complications depends on your individual health and anatomy.

Long-term complications are rare but may include valve deterioration over time, blood clots, or infection. Regular follow-up care helps detect and address any issues early.

Your heart team will discuss your specific risk profile and take steps to minimize complications. They'll also provide clear instructions about warning signs to watch for and when to contact them.

When should I see a doctor after TAVR?

Knowing when to contact your doctor after TAVR is crucial for your safety and peace of mind. While most people recover smoothly, certain symptoms require immediate medical attention to prevent serious complications.

You should contact your doctor immediately if you experience chest pain, severe shortness of breath, dizziness or fainting, or any signs of bleeding. These symptoms could indicate complications that need prompt treatment.

Seek emergency medical care right away if you develop:

• Severe chest pain or pressure
• Sudden, severe shortness of breath
• Fainting or loss of consciousness
• Signs of stroke (facial drooping, arm weakness, speech problems)
• Heavy bleeding from your access site
• Fever over 101°F (38.3°C)
• Sudden leg pain, swelling, or color changes

Contact your doctor's office during business hours for symptoms like mild shortness of breath that's getting worse, swelling in your legs or feet, persistent fatigue, or questions about your medications.

Even if you feel well, keep all your scheduled follow-up appointments. These visits allow your doctor to monitor your valve function and heart health, adjusting your treatment plan if needed.

Don't hesitate to call with concerns or questions. Your heart team wants to ensure you have the best possible recovery and long-term outcome.