Your heart has four valves that open and close, regulating the direction and flow of your blood. One of these valves, the aortic valve, connects your heart to your aorta, the large artery that delivers blood to the rest of your body. Sometimes the aortic valve can become narrowed, a condition known as aortic stenosis, or a heart valve failure. This makes your heart work harder to pump blood to your body and can eventually lead to heart failure. If your aortic stenosis becomes severe enough, you may need a procedure to replace the faulty valve.
For many years, open-heart surgery was performed to replace the aortic valve. But now a minimally invasive procedure called transcatheter aortic valve replacement (TAVR) is an option for many individuals. Here’s some important information about this exciting new treatment.
When TAVR was first introduced in the United States, it was only approved for people with severe aortic stenosis who were too frail to withstand open heart surgery. More recently, TAVR eligibility was expanded to include those who are considered at low and intermediate risk for developing complications after heart surgery. Now, the patient and doctor can decide together whether to move forward with TAVR or surgical aortic valve replacement (SAVR), which involves opening the chest wall.
If you have aortic stenosis and are experiencing symptoms like chest pain, dizziness or shortness of breath, you should be evaluated by a multidisciplinary cardiology team, including cardiologists and cardiovascular surgeons, to determine the best treatment for you. In some cases, SAVR may still be a better option over TAVR.
Unlike SAVR, TAVR is much less invasive. A thin, flexible tube called a catheter is inserted through a blood vessel in your leg or a small incision in your neck or chest. The catheter is advanced to your aortic valve and used to deliver a collapsed replacement valve to that location. Once in the right place, the replacement valve is expanded so it’s situated on top of the old valve and begins functioning. The catheter is then removed. The whole procedure takes 1-2 hours.
Most patients spend a night in intensive care, followed by 2 to 5 days in the hospital. Full recovery can take a few weeks.
All medical procedures involve risks. Even though TAVR is minimally invasive, it’s still a serious heart procedure. You will be closely monitored before, during and after the replacement. Possible complications include:
- Bleeding
- Kidney damage
- Infection
- Damage to the arteries
- Leaking or out-of-place valves
Overall, outcomes for TAVR have been favorable, especially for those who would have previously been unable to receive treatment. But since it’s still relatively new, we don’t know the longevity of the replacement valves. It appears most should last five years or longer, but some people may eventually need a second valve after the first one fails.
In the years since TAVR was first performed, many of the initial issues have been addressed. Thinner catheters are now used, causing less trauma to blood vessels. New generations of artificial valves have been developed to correct previous leaking issues and allow doctors to reposition the valves if necessary. Imaging systems have been improved, making it easier for doctors to select the appropriate type and size of valve for the patient and reducing the need for contrast dyes that can cause damage to the kidneys. Better post-TAVR medication strategies are being utilized to decrease the risk of developing blood clots that lead to strokes.
It can be expected this trend will continue. Future clinical studies will focus on creating better and more durable artificial valves, while also refining the process so it's as effective and safe as possible.
