Transcatheter aortic valve replacement (TAVR)
Transcatheter aortic valve replacement (TAVR) is a minimally invasive heart procedure to replace a thickened aortic valve that can't fully open (aortic valve stenosis). The aortic valve is located between the left lower heart chamber (left ventricle) and the body's main artery (aorta). If the valve doesn't open correctly, blood flow from the heart to the body is reduced.
TAVR can help restore blood flow and reduce the signs and symptoms of aortic valve stenosis — such as chest pain, shortness of breath, fainting and fatigue.
TAVR may be an option for people who are at risk of complications from surgical aortic valve replacement (open-heart surgery). The decision to treat aortic stenosis with TAVR is made after a discussion with a team of heart and heart surgery specialists, who work together to determine the best treatment option for you.
Transcatheter aortic valve replacement may also be called transcatheter aortic valve implantation (TAVI).
Why it's done
Transcatheter aortic valve replacement (TAVR) is a treatment for aortic valve stenosis. Aortic valve stenosis — or aortic stenosis — occurs when the heart's aortic valve thickens and becomes stiff (calcifies). As a result, the valve can't fully open and blood flow to the body is reduced.
TAVR is an alternative to open-heart aortic valve replacement surgery. People who have TAVR often have a shorter hospital stay than those who have surgical aortic valve replacement.
Your doctor may recommend TAVR if you have:
- Severe aortic stenosis that causes signs and symptoms.
- A biological tissue aortic valve that isn't working as well as it should.
- Another health condition, such as lung or kidney disease, that makes open-heart valve replacement surgery too risky.
All surgeries and medical procedures come with some type of risk. Potential risks of transcatheter aortic valve replacement (TAVR) may include:
- Blood vessel complications
- Problems with the replacement valve, such as the valve slipping out of place or leaking (regurgitation)
- Heart rhythm problems (arrhythmias) and the need for a pacemaker
- Kidney disease
- Heart attack
Studies have found that the risks of disabling stroke and death are similar among those who have TAVR and surgical aortic valve replacement.
How you prepare
The treatment team will provide instructions on how to prepare for transcatheter aortic valve replacement (TAVR). Talk to your doctor if you have any questions about the procedure.
Food and medications
Talk to your doctor about:
- When you can take your regular medications and whether you can take them before a TAVR procedure
- When you should stop eating or drinking before the procedure
- Any drug allergies that you have
Clothing and personal items
Your treatment team may recommend that you bring several items to the hospital, including:
- A list of all the medications you take, including those bought without prescriptions
- Eyeglasses, hearing aids or dentures
- Personal care items, such as a brush or comb, toothbrush, and shaving equipment
- Loose-fitting, comfortable clothing
- Items that may help you relax, such as portable music players or books
During your procedure, avoid wearing:
- Contact lenses
- Nail polish
What you can expect
Before the procedure
A specialist will insert an IV into your forearm or hand and may give you a medication called a sedative to help you relax. Medication to prevent blood clots may also be given through the IV. You may also receive medication to reduce the risk of infection.
Hair may be shaved off at the location on your body where the procedure will take place.
During the procedure
Transcatheter aortic valve replacement (TAVR) involves replacing a damaged aortic valve with one made from cow or pig heart tissue (biological tissue valve). Sometimes, the biological tissue valve is placed into an existing biological tissue valve that is no longer working.
Unlike surgical aortic valve replacement, which requires a long incision down the chest (open-heart surgery), TAVR is done using smaller incisions and a thin, flexible tube (catheter) to reach the heart.
To perform TAVR, a doctor inserts a catheter into a blood vessel, usually in the groin or chest area, and guides it into the heart. Moving X-ray images or echocardiogram pictures help the doctor place the catheter into the correct position.
A replacement valve made of cow or pig tissue is passed through the hollow catheter and placed in the area of the aortic valve. A balloon on the catheter tip inflates to press the new valve into place. Some valves expand without the use of a balloon.
The doctor removes the catheter once the new valve is securely in place.
During the TAVR procedure, the treatment team will carefully monitor your vital signs, including blood pressure, heart rate and rhythm, and breathing.
After the procedure
You may spend the night in the intensive care unit (ICU) for monitoring after your procedure. How long you need to stay in the hospital after TAVR depends on many things. Some people who have TAVR go home the next day.
Before you leave the hospital, your treatment team will explain how to care for any incisions and how to watch for signs and symptoms of infection. Warning signs of infection include fever, increased pain, and redness, swelling, draining or oozing at the catheter site.
Several medications may be prescribed after TAVR, including:
- Blood thinners (anticoagulants). Blood-thinning medication is prescribed to prevent blood clots. Your doctor will explain how long you may need to take this medicine. Always take medications as prescribed.
- Antibiotics. Artificial heart valves can become infected with bacteria. Most bacteria that cause heart valve infections come from the bacteria in the mouth. Excellent dental hygiene, including routine dental cleanings, can help prevent these infections. Antibiotics are prescribed for use before certain dental procedures.
Regular doctor's checkups and imaging tests are needed after TAVR to make sure the new valve is working properly. Let your doctor know if you have any new or worsening signs or symptoms, including:
- Dizziness or light-headedness
- Swelling of the ankles
- Sudden weight gain
- Extreme tiredness with activity
- Signs or symptoms of infection
Seek emergency medical help if you have:
- Chest pain, pressure or tightness
- Severe, sudden shortness of breath
Transcatheter aortic valve replacement (TAVR) may relieve the signs and symptoms of aortic valve stenosis, which may help improve quality of life.
Following a heart-healthy lifestyle is important as you recover and to help prevent further heart problems. After TAVR:
- Don't smoke.
- Eat a heathy diet rich in fruits and veggies and low in salt (sodium) and saturated and trans fats.
- Get regular exercise — talk to your doctor before starting a new exercise routine.
- Maintain a healthy weight.
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