What Is Transcatheter Aortic Valve Replacement (TAVR)?

Transcatheter aortic valve replacement (TAVR) surgically and artificially replaces an aortic valve narrowed by aortic stenosis.

Sometimes, malfunction of the heart valves can lead to issues with blood flow and threaten the overall health of an individual. 

Stenosis, more specifically aortic stenosis (AS), is narrowing of the aortic valve (one of the important heart valves) opening. It can be caused by age, genetic predisposition, radiation and/or buildup on the leaflets of calcium, cholesterol (fat), etc. 

This results in stiff valve leaflets that don't move easily or open fully. This reduces the pumping ability of the heart to push blood through the aortic valve to the body. Regurgitation happens when the valve has become damaged or worn out and the blood leaks backward. AS can sometimes lead to heart failure or even sudden death.

Patients with AS exhibit the following symptoms: 

• Shortness of breath   
• Dizziness or fainting
• Chest pain
• Feeling tired or fatigued
• Swelling in the legs

Transcatheter aortic valve replacement (TAVR), also called transcatheter aortic valve implantation (TAVI), is a surgical procedure to artificially replace a narrowed heart valve called the aortic valve (which fails to open properly due to aortic valve stenosis). TAVR is a minimally invasive procedure that repairs the narrowed aortic valve without major surgery. 

This procedure does not require stopping the heart or opening the chest cavity. The artificial valves are constructed from a combination of a metal mesh and animal tissue. Artificial valves are delivered via a thin wire (catheter) and expanded in place over the existing valve. Once in place, the valve immediately begins functioning. TAVR can improve survival in people who can't undergo major surgery.

Transcatheter aortic valve replacement (TAVR) is usually done under general anesthesia. The patient is also given intravenous medication to prevent blood clots, and their condition is monitored throughout the procedure. 

• The doctor may access the patient’s heart through a blood vessel in the leg or through a tiny incision in the chest. The doctor may sometimes use other approaches to access the heart. 
• A catheter (hollow tube) is inserted through the access point. The doctor uses advanced imaging techniques to guide the catheter through the blood vessels, to the heart and into the aortic valve.
• Once the new valve is positioned, a balloon on the catheter’s tip is inflated to expand the replacement valve into the appropriate position. Some valves can expand without the use of a balloon.
• When the doctor is certain that the valve is securely in place, the catheter is removed.
• The opening is sealed with stitches, and the patient may be monitored in the intensive care unit (ICU).

All medical procedures come with some type of risk. The risks of transcatheter aortic valve replacement (TAVR) may include the following:

• Bleeding
• Blood vessel complications
• Problems with the replacement valve such as the valve slipping out of place or leaking
• Stroke
• Arrhythmias (heart rhythm problems) and the need for pacemaker placement
• Kidney disease
• Heart attack
• Infection
• Death
• Anesthesia complications such as headache, drowsiness, and sometimes vomiting

Usually, patients are discharged within two days after the procedure. Patients may be on painkillers, antibiotics, and anti-blood clot medications for a week or 10 days. Patients can enroll in a cardiac rehabilitation program after 10 days. Patients recover within a month after the procedure. Research shows the procedure has improved health and quality of life within 30 days after the procedure.