Transcatheter Aortic Valve Replacement (TAVR)

What Is Transcatheter Aortic Valve Replacement (TAVR)?

The aortic valve is located between the pumping chamber on the left side of the heart and the aorta, a major artery. The aorta carries oxygen-rich blood from the heart to the rest of the body. The valve should be closed while the heart is filling with blood. When the heart chamber squeezes to push blood into the aorta, the valve should open fully to allow blood flow.

Aortic stenosis is a condition that results from narrowing of the aortic valve. (The most common cause of aortic stenosis is degeneration from age-related calcium deposits.) This narrowing can put more stress and pressure on the heart muscle, which can lead to symptoms including chest discomfort or pain, shortness of breath, leg swelling, fatigue, or fainting. Left untreated, the heart muscle can weaken over time, resulting in worsening of symptoms and premature death.

Reasons for Procedure

Transcatheter aortic valve replacement (TAVR) is a method for replacing an aortic valve that is severely narrowed due to aortic stenosis without making a full chest incision (the conventional or traditional approach). Instead, TAVR uses a method that is much less invasive.

Alternatives to TAVR

• Medical therapy. Certain medications may be prescribed to alleviate some of the symptoms of aortic stenosis. However, these do not stop the progression of the disease.
• Balloon aortic valvuloplasty. A balloon is inserted into your aortic valve through a catheter and this temporarily enlarges the valve opening. This may result in a three to six month improvement of symptoms, but has not been shown to prolong your life.
• Conventional aortic valve replacement. Your aortic valve is replaced through a large incision on the front of your chest while you are connected to a heart–lung machine.

Description of Procedure

Before you are brought to the operating room (OR), you will have IVs placed and your skin prepped. Once in the OR, a breathing tube will be placed in your throat and you will be given anesthesia until you are fully asleep.

The two most common approaches for the TAVR procedure are:

• Transfemoral. A catheter is inserted through the artery in your groin area and carefully passed up into the heart. Your new valve is then implanted through this catheter inside the narrowed valve.
• Transapical. A tiny incision is made in your chest wall and the new valve is implanted directly into your heart inside the narrowed valve.

Possible Complications

If you are planning to have a valve replacement surgery, your doctor will review a list of possible complications, which may include:

• Bleeding
• Blood clot formation that leads to a stroke or kidney damage
• Complications from anesthesia
• Infection
• Irregular heart rhythm
• Scarring
• A valve that does not function correctly

Some factors that may increase the risk of complications with heart surgery include:

• Chronic illness, including high blood pressure and diabetes
• Increased age
• Infections
• Lung conditions
• Obesity
• Other heart conditions
• Smoking

What to Expect

Prior to Procedure

Before your procedure you will meet with one or more physicians to discuss your history. You will then likely be referred for further testing that can help determine if the TAVR procedure is right for you. This testing may include:

• Cardiac catheterization: A small catheter is threaded into your heart from a blood vessel in your arm or leg. This is done to obtain images of your coronary arteries.
• Transesophageal echocardiogram: A small camera is passed through your esophagus to obtain high-quality images of your heart.
• Computerized tomography (CT) of chest, abdomen, and pelvis: Contrast solution is injected into a vein and then CT scans are taken to determine the best approach and valve size.

Talk to your doctor about your medication. You may need to stop taking certain medication for one week before surgery, such as:

• Blood-thinning drugs, such as warfarin (Coumadin)
• Anti-platelet drugs, such as clopidogrel (Plavix)
• Diabetes medications, such as metformin (Glucophage)

Your doctor may also instruct you to:

• Not eat or drink anything after midnight of the night before your procedure, unless told otherwise by your doctor.
• Arrange for a ride to and from the hospital
• Arrange for help at home after the procedure

Anesthesia

TAVR is done with general anesthesia. You will be asleep.

Immediately Afterwards

You will be monitored in an Intensive Care Unit (ICU) after the procedure. When you wake up, you will notice that you are attached to a number of devices, including:

• Monitors to track your heart rate, breathing rate, blood pressure, and the percentage of oxygen in your bloodstream
• A ventilator tube in your mouth and lungs to breathe for you, or an oxygen mask or tube to give you extra oxygen
• Tubes to drain extra fluid from your chest
• A tube that goes into your nose and down to your stomach to drain your stomach of excess fluid and gas
• A catheter in your bladder to drain urine
• An IV to provide fluids, electrolytes, and pain medicines directly into a vein

Postoperative Care

At the Hospital

In the Intensive Care Unit (ICU), you will be cared for by skilled critical care physicians, Physician Assistants (PAs), Nurse Practitioners (NPs), nurses, therapists, and technicians. Once you are awake and able to breathe on your own, the breathing tube will be removed. The nurses will assist you with coughing, deep breathing and getting out of bed. These are important keys to your recovery. When you are ready to leave the ICU you will move to a hospital bed for your continued recovery.

Back at Home

It is very likely that you will go to a short-term rehabilitation facility. The facility will be determined by your medical needs in conjunction with a social worker, you, and your family. At rehab, the focus is to regain your physical strength and to return you to your everyday activities. While at rehab, Nurse Practitioners from our TAVR team will be in contact with the health care providers at the rehabilitation facility to assess your progress and provide continuity of care.

Recovering after Surgery: What to Expect

It is important for you to remember that the full recovery from your TAVR will take time. All patients take their own course, and some make faster or slower progress than others. Most patients have improvement of symptoms in four to six weeks.

When to Call Your Surgeon

After you leave the hospital, contact your surgeon if any of the following occurs::

• Any wound drainage
• Chest pain
• Chills
• Increased leg swelling
• Shortness of breath while at rest
• Temperature greater than 100 degrees
• Weight gain equal to or greater than 3 pounds

In case of an emergency, call for medical help right away.

Frequently Asked Questions

How long will it take?

The procedure can take anywhere from 2 to 4 hours.

How much will it hurt?

Anesthesia will block pain during the surgery. You will be given pain medicine to help manage the pain after the surgery.

What is the average hospital stay?

The usual length of stay is 5 to 7 days. The length of stay will depend on your overall health and your recovery progress.

Meet with a Doctor within One Week

To learn more about how we can help you, contact us. We’ll return your call the same day and can secure you an appointment with one of our doctors within the week.

Call 617.789.2045 to request an appointment.

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