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Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement (TAVR), also known as transcatheter aortic valve implantation (TAVI), is a surgical procedure that may be recommended to some patients diagnosed with structural heart disease, which affects the heart valves. TAVR surgery is a minimally invasive procedure involving a thin tube called a catheter inserted through an artery leading to the damaged valve. A new valve will replace the diseased aortic valve. Some valve implants can expand independently, while others need a balloon. This new artificial valve will take over the function of regulating blood flow.

What Is an Aortic Valve?

The heart has four valves to help the blood flow in the right direction. Healthy valves open and close properly so blood does not flow backward between chambers. The aortic valve is one of the heart’s four valves, and it helps prevent the backflow of blood from the aorta to the left ventricle. A diseased aortic valve does not function properly, requiring the heart to pump harder to ensure enough blood supply to the rest of the body. Aside from stenosis (narrowing), other conditions affecting the aortic valve include:

  • Prolapse – the valve’s leaflets do not correctly close
  • Regurgitation – the blood leaks backward through the valve

What Is a TAVR Valve Made Of?

The TAVR valve is typically made from two main components:

  • Tissue leaflets: These thin flaps within the valve control blood flow. They are most commonly made from biological tissue from an animal.
  • Valve frame: This supportive structure holds the leaflets in place. The frame is usually made from durable metal such as:
    • Nitinol: This shape-memory alloy commonly used in TAVR valves due to its flexibility and ability to conform to the heart's anatomy during implantation.
    • Stainless steel: In some cases, stainless steel might be used for the frame, although nitinol is generally preferred due to its flexibility benefits.

How Is TAVR Done?

Before TAVR heart surgery, your healthcare provider will perform tests to ensure that TAVR is right for you, such as blood tests, electrocardiogram, echocardiogram, computed tomography (CT scan) and coronary angiogram. You will change into a hospital gown and remove any jewelry. Medications may be given to help you relax. An IV will be placed into the vein in your arm or hand. Machines will help your healthcare team monitor your vital signs during the procedure.

During the TAVR cardiac surgery, a thin tube called a catheter will be inserted through an artery leading to the damaged valve. A new valve will be placed inside the old valve. The new valve will help regulate blood flow. The two most common approaches to performing the TAVR surgery are:

  • Transfemoral: the surgeon accesses the damaged valve through the femoral artery instead of a chest surgical incision, which is more invasive.
  • Transapical: a minimally invasive procedure where a surgeon makes a small cut in the chest and enters the heart through its apex.

How Long Does a TAVR Procedure Take?

TAVR heart procedure may take up to 90 minutes to complete, while open-heart surgery may take up to four to six hours. TAVR is often associated with faster recovery than open-heart surgery since TAVR involves using minimal incisions in the skin, compared to larger incisions from an open-heart procedure.

Who Qualifies for TAVR Procedure?

Patients with severe aortic stenosis may benefit from transcatheter aortic valve replacement surgery. Aortic stenosis is the narrowing of the aortic valve opening, resulting in restricted blood flow from the left ventricle to the aorta.

Symptoms of aortic stenosis include:

  • Chest pain
  • Decline in activity level
  • Difficulty sleeping
  • Fluttering or rapid heartbeat
  • Lightheadedness
  • Swollen feet or ankles
  • Trouble breathing

The doctor will consider various health information including medical history, lifestyle, test results and personal preferences, to evaluate a patient for TAVR. However, a patient might not be a good candidate for TAVR if their blood vessels and valve are not the right size for TAVR, their heart is too weak, they have untreated heart conditions, aortic problems, had a heart attack in the last 30 days or have an infection or severe illness.

What Is the Recovery Time for TAVR?

The wound from the TAVR catheter incision site may take about two weeks to heal. Follow your doctor’s instructions for dressing, covering and keeping the wound dry. At the end of the two weeks, the doctor may need to remove the wound staples or stitches. Your incision site may remain bruised for a few weeks more. Contact your doctor if your wound is swollen, feels warm, is bleeding, draining excess fluid or is reopening. Based on the 2017 AHA/ACC Valve Guidelines, a TAVR patient must undergo an anti-platelet therapy consisting of these medications and dosages:

  • Lifelong aspirin at 75 to 100 mg dosage
  • Six months of clopidogrel at 75 mg dosage

Antiplatelets prevent blood clots from forming in a patient’s artificial heart valves, surgical stents and other cardiovascular implants. Unwanted blood clots may lead to stroke or heart attack. Some TAVR patients may need a permanent pacemaker to regulate their heartbeat and improve their survival. If you are a TAVR patient, here are some of the discharge instructions you can expect to receive:

  • Maintain a heart-healthy, low-salt and low-fat diet with additional restrictions based on your other existing health conditions.
  • Keep surgical incision sites dry, clean and without bandages.

Seek medical care if you experience any or a combination of the following symptoms:

  • Chest pain
  • Fever
  • Nausea
  • Shortness of breath
  • Severe and persistent abdominal pain
  • Swelling, redness or drainage from the surgical wound
  • Vomiting

Find a Cardiothoracic Surgeon

Schedule a consultation with one of our surgeons to learn more about your treatment options. Call 210-798-4311 to book an appointment.