Transcatheter Aortic Valve Replacement (TAVR)

TAVR is a treatment for aortic valve stenosis, in which the aortic valve becomes thickened, stiff and narrowed. This restricts the flow of blood across the valve, forcing the heart to pump harder.

The narrowing of the aortic valve occurs due to age-related wear and tear. Other conditions, such as rheumatic heart disease or a congenital aortic valve, can cause this wear and tear to occur at an earlier age.

TAVR is an alternative to open heart aortic valve replacement surgery. People who undergo TAVR typically have a shorter hospital stay than those who undergo open heart surgery. It can be used to treat narrowing of a native valve or narrowing of a previously placed biological tissue valve, including a prior TAVR.

All medical procedures and surgeries carry some level of risk. The risks associated with TAVR include:

• Bleeding
• Damage to the blood vessels of the groin
• Stroke
• Heart rhythm problems, including needing a pacemaker
• Worsening kidney function
• Heart attack
• Infection
• Low blood pressure
• Death

The risks of significant stroke and death are similar to those with open heart valve replacement surgery.

TAVR isn’t for everybody and may not be recommended for patients who have had a recent heart attack, recent stroke or significant chronic kidney disease.

Make sure the structural heart team knows all your medications, including supplements, as well an any allergies you have. Before the TAVR, the structural heart team will review your medications and indicate if any need to be held. You will need to be on an empty stomach with nothing to eat or drink after midnight prior to the procedure. Sips of water with medications that are not being held are fine.

You will be asked to bring to the hospital your eyeglasses, hearing aids, and/or dentures as well as personal care items such as toothbrushes, combs, brushes and shaving equipment. Please bring loose, comfortable clothing.

Contact lenses, dentures, eyeglasses, jewelry and nail polish should not be worn during the procedure itself.

At the beginning of the procedure, you’ll receive anesthesia to keep you from feeling pain. You’ll also receive an intravenous blood thinner to prevent blood clots. TAVR uses catheters, typically inserted through the groin. The catheter is advanced to the heart under image guidance with x-rays. It is placed inside the old aortic valve and is expanded. The leaflets of the old valve are pushed aside by the new valve. The valve is evaluated with a transesophageal echocardiogram to check for leaks or other issues. The catheter is removed from the body and the entry point is stitched up.

Most people who get TAVR can leave the hospital within one day, but recovery time may increase based the individual health of the patient. Most people can also return to normal activity within days of the procedure. You will have to wait two weeks before you can lift any objects heavier than 10 lbs. You will have to wait one week before driving.

You can expect a checkup with your provider one month after the procedure and typically one year after that. You will likely be referred to a cardiac rehabilitation program, as well, to help with recovery.

Antibiotics may be prescribed in the future to be taken before dental procedures to reduce the risk of infections.