Transcatheter aortic valve replacement (TAVR), also known as TAVR or transcatheter aortic valve implantation (TAVI), is a procedure to treat aortic stenosis, a narrowing of the aortic valve. The narrowing blocks the flow of blood to your body and forces your heart to work harder. This causes symptoms such as chest pain and shortness of breath.
TAVR replaces an aortic valve that is not working properly or is diseased with an aortic valve made from animal tissue. The TAVR procedure is minimally invasive, requiring only a small cut in the skin. It does not require open-heart surgery.
The aortic valve is one of four valves that control blood flow in the heart. The aortic valve specifically controls the blood that runs from the heart through your aorta and to the rest of the body. Over time or because of a congenital heart defect, you can develop aortic stenosis, a type of heart valve disease. Your healthcare provider may explain risks and benefits of both TAVR and open heart surgery. This information will help you decide which one is better for your specific needs.
How it works
There are several ways your doctor can perform TAVR, depending on your health and the health of your blood vessels.
- A TAVR using the femoral artery, a blood vessel in your groin or thigh, is the most common. Your doctor guides a tube with the replacement valve through the femoral artery to the heart.
- Blood vessels in the chest may be used by the doctor to guide the tube to your heart if your femoral artery is too small or damaged. This approach is called transapical access.
- Stomach area blood vessels may be used for TAVR if a patient’s leg arteries are too small or diseased for a more standard approach. NHLBI researchers developed this approach, called transcaval access, to make TAVR available to high-risk patients. It is less common. The doctor makes holes in both the vena cava, major veins in your stomach area, and the nearby aorta to feed the tube with the replacement valve first through the vein and then through the aorta to the heart. You may be able to stay awake during this procedure. This type of TAVR approach may benefit women, who often have smaller blood vessels than men.
- Accessing the heart from the vessel under the clavicle, or collar bone, may be an option if you have had heart surgery before or if you have another condition that makes it difficult to access other parts of the chest.
- Your doctor may use the carotid artery in the neck to feed the tube to the heart — called transcarotid access. This type of procedure is rare but may be used when other options will not work.
- Another rare location is through the septum, the wall of tissue that separates the right and left atria of the heart. Your doctor reaches the damaged valve by guiding the tube through a blood vessel from your thigh to the heart.
New approaches to TAVR are making the procedure available to more people.
As with any medical procedure, there are certain risks associated with a TAVR procedure. In some patients, a replacement valve can push aside an old valve flap, blocking blood flow to the heart. The result — coronary artery obstruction — is a rare but life-threatening complication of TAVR. NHLBI researchers have invented a technique called the BASILICA procedure to prevent it.
What to expect during the procedure
Cardiologists, or doctors who specialize in the heart, typically perform TAVR in a hospital. Before TAVR, your healthcare providers will measure the valve opening, then give you medicines that relax you or put you to sleep, as well as medicines to prevent dangerous blood clots.
During the procedure, your doctor will guide a thin, flexible tube called a catheter to your heart through blood vessels they can access from your groin or thigh, stomach area, chest, neck, or collar bone. Inside the catheter is a folded replacement valve, which is placed securely within the old valve. Once your doctor is sure the new valve has been placed correctly, they will check for leaks and possible complications, such as a problem in the heart’s electrical signaling.
What to expect after the procedure
After a TAVR procedure, your hospital stay may be just a few days depending on the approach used. You may be able to return to daily activities, such as exercising and driving, in just a few weeks.
However, as with any procedure involving the heart and blood vessels, TAVR carries some risks both during and after surgery, including:
- Damage and bleeding where the catheters were inserted
- Injury to the kidneys or the heart
- Leaking in the new valve because it does not fit well
- Need for a permanent pacemaker due to damage to the heart’s electrical signaling during the procedure
- Stroke
You may get medicine to prevent infection or abnormal blood clots. About a month after the procedure, your provider will do tests to check how well the valve is working and how well you are healing. You may need follow-up visits every year to make sure the valve continues working as it should.
