Transcatheter Aortic Valve Replacement (TAVR)

What is transcatheter aortic valve replacement (TAVR)?

TAVR—also called transcatheter aortic valve implantation, or TAVI—is a nonsurgical procedure to replace a diseased aortic valve with one made from animal tissue. The aortic valve is one of four heart valves. It controls blood flow from the heart’s lower left chamber (left ventricle) into the aorta (the body’s largest artery).

“Transcatheter” means a doctor replaces the aortic valve using a thin, flexible tube called a catheter. They thread the catheter through an artery using a single small incision.

At one time, TAVR was approved only for patients at high risk for surgical aortic valve replacement (SAVR), an open-heart procedure. Today, most people who need a new aortic valve get a TAVR procedure. Compared to SAVR, this minimally invasive treatment reduces the risk of blood loss, scarring, infections, and other complications. It may also help you leave the hospital sooner and recover faster with less pain.

At Mass General Brigham Heart and Vascular, we offer advanced treatments for common to complex heart valve problems. Our Heart Valve Disease Treatment Program is one of the largest, most experienced in the nation with success rates above national and regional averages.

TAVR surgical appoaches

There are different ways to perform TAVR. The most common way to perform the procedure is through the femoral artery in the groin. Your heart team will discuss the safest way to access and replace your aortic valve.

Who need TAVR?

Your healthcare provider may recommend TAVR if you have aortic valve stenosis or aortic valve regurgitation. Aortic stenosis refers to the narrowing of the aortic valve opening, which restricts blood flow from the heart to the aorta and the rest of the body, leading to insufficient oxygenated blood supply to organs. Aortic valve regurgitation occurs when the aortic valve doesn’t close properly, causing blood to flow backward into the left ventricle as your heart is relaxing.

Aortic valve disease can develop for many reasons, such as:

• Aging
• Calcium buildup on the aortic valve (calcification)
• Congenital heart disease, such as bicuspid aortic valve
• Endocarditis (infection of the heart’s lining)
• High blood pressure or high cholesterol
• Rheumatic heart disease

Your provider will consider several factors to determine if TAVR is the right procedure for you. These factors include your health history, disease severity, and need for other heart procedures. When possible, we recommend minimally invasive procedures like TAVR to minimize complications and ease your recovery.
 

TAVR benefits

TAVR restores the flow of oxygenated blood from your heart to the rest of your body and organs. By reducing strain on your heart, it can lower your risk of heart failure. It also relieves aortic valve disease symptoms, such as chest pain, shortness of breath, and extreme fatigue.

Because TAVR is a minimally invasive procedure performed through small skin incisions, it has a lower risk of complications than open-heart cardiac surgery. You benefit from:

• Minimal blood loss, scarring, and pain
• Shorter hospital stay and overall recovery time
• Faster return to normal activities

TAVR risks

As with any heart procedure, there’s a risk of bleeding, infection, blood clots, and other problems. Treatments can also cause heart rhythm changes (cardiac arrhythmia), strokes, or other issues. Our heart specialists perform a high volume of TAVR procedures every year and have the expertise to lower the chance of complications and achieve a higher success rate.

Preparing for a TAVR procedure

Your heart team will guide you through the steps to prepare for TAVR. Before the procedure, you may need to:

• Get blood tests.
• Undergo heart tests, including echocardiogram, electrocardiogram (ECG/EKG) and cardiac MRI.
• Change or stop taking certain medications in the days leading up to the procedure.
• Avoid eating or drinking on the day of the procedure.
• Prepare for recovery by arranging any at-home support you may need after the procedure.

What to expect during a TAVR procedure

An interventional cardiologist specializing in catheter heart procedures performs TAVR. The procedure typically takes one to two hours. You will receive sedative medications to keep you comfortable during the procedure and blood-thinning medication through an IV to lower the risk of blood clots.

During TAVR, a skilled interventional cardiologist:

1. Makes a small incision in the groin and, potentially, the wrists.
2. Inserts a catheter carrying a replacement valve.
3. Uses X-rays or other imaging to guide the catheter with the valve to the heart.
4. Deploys the valve, pushing the diseased valve aside.
5. Places and secures the artificial valve.
6. Checks for any issues, such as a leaky valve.
7. Removes the catheter.
8. Seals the artery with a closure device.

Recovery after a TAVR procedure

After the procedure, you may need to lie on your back in bed for a few hours to lessen the risk of bleeding from the incision site. We will monitor you to keep you as comfortable as possible. Most people go home the next day, but everyone’s recovery experience is different.

After the procedure, you will have follow-up visits with your care team to make sure that the new valve works properly. Your care team may also recommend cardiac rehabilitation to strengthen your heart. Most people notice a significant improvement in symptoms 30 days after TAVR. A full recovery may take several months.

FAQs about TAVR