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Transcatheter Aortic Valve Replacement (TAVR)

What is Transcatheter Aortic Valve Replacement

Transcatheter Aortic Valve Replacement (TAVR), also known as Transcatheter Aortic Valve Implantation (TAVI), is a minimally invasive heart surgery used to treat a condition called aortic valve stenosis.

This procedure allows the replacement of the aortic valve without the need for open-heart surgery. It is particularly beneficial for patients who are at high risk for complications from traditional surgery.

Benefits of Transcatheter Aortic Valve Replacement

TAVR is a breakthrough procedure that effectively treats aortic valve stenosis, particularly for patients at high risk for open-heart surgery.

  • Less Invasive: Unlike traditional valve replacement, TAVR is performed through a small incision, usually in the femoral artery, reducing the trauma to the body.
  • Shorter Recovery Time: Patients typically experience a faster recovery compared to open-heart surgery, with less pain and a shorter hospital stay.
  • Option for High-Risk Patients: TAVR provides a life-saving option for patients who are considered too high-risk for traditional valve replacement surgery.
  • Improved Symptoms: Most patients experience significant relief from chest pain, shortness of breath, and fatigue.

What is Aortic Valve Stenosis?

Aortic valve stenosis is when the aortic valve, which regulates blood flow from the heart to the rest of the body, becomes narrowed. This narrowing can restrict blood flow, making the heart work harder to pump blood through the valve. Over time, this can lead to heart failure, arrhythmias, and other serious complications.

Symptoms of Aortic Valve Stenosis

Common symptoms of aortic valve stenosis include:

  • Chest pain
  • Shortness of breath
  • Dizziness or fainting
  • Fatigue
  • Irregular heartbeats

Who is Suitable for TAVR?

As with any medical procedure, a thorough evaluation by a healthcare team is crucial to ensure the best outcome for each individual.

TAVR is typically recommended for patients with severe aortic valve stenosis who are considered high-risk or ineligible for traditional open-heart surgery. These patients often include:

  • Older adults with other medical conditions
  • Patients with weakened heart function
  • Individuals with previous heart surgeries
  • People who have been assessed as high-risk by a heart team (cardiologists and heart surgeons)

In recent years, advancements in the procedure have made TAVR more widely available, even for patients who are at intermediate or lower surgical risk.

About TAVR Procedure

During TAVR, a catheter (a thin, flexible tube) is inserted through a blood vessel, usually in the groin or chest. The catheter is guided to the heart, and a new aortic valve is delivered through it.

Once in place, the new valve is expanded, either with a balloon or by self-expansion, pushing aside the old, narrowed valve and allowing the new valve to take over its function.

The new valve is typically made from animal tissue (often from cows or pigs), which is durable and functions similarly to a human valve.

TAVR Procedure Steps

  • Preparation: Patients are given anaesthesia to ensure comfort during the procedure. It can be performed under general or local anaesthesia, depending on the patient's condition.
  • Insertion of the Catheter: The doctor inserts a catheter into a blood vessel, usually through the femoral artery in the groin, though sometimes access may be obtained through the chest or another artery.
  • Delivery of the New Valve: A replacement valve is mounted on the catheter and guided to the heart. Advanced imaging techniques, such as echocardiography and fluoroscopy, help the doctor guide the catheter precisely to the damaged valve.
  • Valve Placement: Once the new valve reaches the aortic valve, it is expanded, displacing the old valve and positioning the new one.
  • Catheter Removal and Closure: After the new valve is securely in place and functioning, the catheter is removed. The incision in the blood vessel is closed, and recovery begins.

What to Expect After TAVR Surgery?

The recovery from TAVR is generally faster than recovery from open-heart surgery. Many patients can return to normal activities within a few days or weeks, depending on their overall health before the procedure. Hospital stays typically last between 2 to 5 days, though some patients may be discharged sooner.

Post-procedure care may involve:

  • Monitoring for potential complications, such as bleeding, infection, or valve-related issues
  • Blood-thinning medications to reduce the risk of clot formation
  • Follow-up appointments with the heart team to ensure the new valve is functioning properly

Risks and Complications

As with any medical procedure, TAVR carries some risks, though they are generally lower than those associated with open-heart surgery. Potential complications include:

  • Bleeding at the catheter insertion site
  • Blood vessel damage
  • Stroke or transient ischemic attack (TIA)
  • Kidney damage
  • Problems with the new valve, such as leaks or improper function
  • Heart rhythm abnormalities requiring a pacemaker

It’s essential for patients to discuss the potential risks and benefits with their healthcare provider to determine if TAVR is the right choice for them.

Prognosis After Transcatheter Aortic Valve Replacement

Most patients who undergo TAVR experience a significant improvement in their quality of life. Symptoms like shortness of breath, chest pain, and fatigue usually decrease or disappear, allowing patients to return to their normal activities.

Long-term studies have shown that the new valves used in TAVR are durable and effective for many years in most patients.

Alternatives to TAVR

  • Open-Heart Surgery (Surgical Aortic Valve Replacement - SAVR): Traditional valve replacement surgery is still an option, especially for younger or healthier patients. SAVR involves opening the chest to replace the damaged valve.
  • Medication: In some cases, medications can help manage symptoms of aortic stenosis, but they do not address the underlying problem.
  • Watchful Waiting: For patients with mild or moderate aortic stenosis, doctors may recommend monitoring the condition closely without immediate intervention.