What is Transcatheter Aortic Valve Replacement (TAVR) Procedure?What is Transcatheter Aortic Valve Replacement (TAVR)?
Transcatheter aortic valve replacement (TAVR), also sometimes known as transcatheter aortic valve implantation (TAVI), is a procedure used to treat the narrowing of the aortic valve, also called aortic stenosis. Aortic stenosis forces the heart to work harder than it should because it blocks the normal flow of blood to the body. When this occurs, it can cause chest pain and/or shortness of breath.
One of the most promising procedures for select patients with severe symptomatic aortic stenosis (narrowing of the aortic valve opening) is Transcatheter Aortic Valve Replacement (TAVR). TAVR allows doctors to implant a device into a heart valve without open surgery.
Do I Qualify for TAVR?Do I Qualify for TAVR?
Having a heart valve replacement can be scary. Fortunately, TAVR, a less invasive procedure, is a viable option for more patients than ever. This procedure was initially approved for patients aged 60 and older who were considered at high risk for complications from open-heart surgery.
Now, the US Food and Drug Administration has cleared the use of TAVR in patients with severe symptomatic aortic stenosis who are low risk for surgical intervention, sparing them from open-heart surgery. This change means more people living with severe aortic stenosis may be candidates for the procedure.
In national clinical trials led by NewYork-Presbyterian physicians, TAVR was found to be at least as effective as and sometimes superior to surgery for younger and more active patients. Patients who underwent TAVR had shorter hospital stays, lower mortality rates, and higher blood flow performance.
How is a TAVR Performed?Procedure
TAVR is an alternative to traditional heart valve replacement requiring open-heart surgery. Since TAVR is done through tiny openings, all chest bones are left in place, and there are no large incisions.
The procedure is completed as follows:
- Surgeons insert a thin, flexible tube called a catheter into a blood vessel through a small incision in the patient's leg or groin. These blood vessels can also be accessed through the stomach area, chest, neck, or collarbone.
- Surgeons guide the catheter containing a replacement valve to the heart and carefully position the new device securely within the old valve.
- The catheter is removed once the new valve has been checked for leaks or other problems.
The TAVR procedure is performed while the patient is under general anesthesia, and patients may be discharged from the hospital within 48 hours.
NewYork-Presbyterian physicians were the principal investigators of the national clinical trials establishing the effectiveness of this minimally invasive procedure.
Dr. Susheel K. Kodali, is the co-director of the Structural Heart & Valve Center at NewYork-Presbyterian/ Columbia University Medical Center. Thanks to the transformative work of interventional cardiologists and cardiac surgeons at NewYork-Presbyterian like Dr. Kodali, Transcatheter Aortic Valve Replacement (TAVR) has progressed dramatically in terms of device technologies and patient selection.
What are the Risks of a TAVR?Risks
The possibility of risk exists for any medical procedure. Many of the associated complications require additional medical or surgical intervention. It is essential to talk to your doctor to ensure you thoroughly understand the possible risks and how they compare to the procedure's benefits.
Common risks associated with TAVR include:
- Damage to the blood vessels
- Leaking of the replacement valve
- Kidney failure
- Heart attack
Preparing for a Transcatheter Aortic Valve ReplacementPreparing
As with any surgery, there are things to think about and do in the weeks prior to a TAVR procedure. Specific instructions from the doctor should always be followed in addition to the following:
- Following a healthy diet and discussing with your doctor when to stop eating and drinking before the procedure
- Discussing your current medications with your doctor and determining which ones should or should not be taken before the day of the procedure
- Developing a recovery plan that includes details about care at home once you are released from the hospital
- Getting a dental checkup before the procedure since oral bacteria can cause infection of the heart valve
What Should I Expect After a TAVR?What Should I Expect After a TAVR?
Hospital stays following TAVR are generally just a few days. Generally, patients recover in the ICU or recovery room immediately following the procedure before moving to their regular rooms. While in the hospital, patients usually receive medicines to prevent infection and blood clots. Specific instructions and more about what to expect during recovery are shared with patients by their doctors before leaving the hospital.
Patients are often able to return to normal daily activities including exercise and driving within a few weeks, and many patients notice relief from symptoms within 30 days after the TAVR procedure.
Receive a TAVR at NewYork-Presbyterian
For patients with severe aortic stenosis, an appointment with a New York-Presbyterian cardiologist or cardiac surgeon is an important first step. A consultation with one of NewYork-Presbyterian's cardiac specialists will determine if a TAVR is the correct procedure.
With more top heart doctors that any other hospital in the country, NewYork-Presbyterian's cardiac team provide world-renowned cardiovascular care for both adults and children. Cardiac surgery, including TAVR, is only one of many reasons to turn to New York-Presbyterian for matters of the heart.
NewYork-Presbyterian's cardiac specialists are currently performing more than 500 Transcatheter Aortic Valve Replacement (TAVR) cases per year, with 70% of our patients discharged in two days or less.