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Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure that enables a collapsible aortic heart valve to be placed inside the heart. During the procedure, the TAVR device is crimped down and placed into the body via a catheter that is inserted in the upper thigh or groin. Once it’s delivered to the site of the patient’s diseased valve, the device is expanded with a balloon and begins to work immediately.
TAVR offers some patients the potential of a longer, better quality life. When TAVR was first introduced, it was only approved for patients who were not candidates for traditional open-heart surgery. Changes to the requirements now mean that patients with valve disease who are deemed high or intermediate risk may also be appropriate.
To assess whether someone is a candidate for TAVR, patients with severe aortic valve disease are screened in CHI Memorial Hospital’s Heart Valve Program. This program is directed by a team of specially trained cardiovascular surgeons, interventional cardiologists, and imaging cardiologists who review possible candidates to determine if TAVR is the best course of treatment for each individual patient.
More than 700 patients have been treated with lifesaving TAVR therapy at CHI Memorial.
The Edwards SAPIEN Valve was the first TAVR therapy to receive FDA approval. In October 2011, when CHI Memorial was selected, it was one of only 24 hospitals nationwide chosen to use the device. CHI Memorial performed the third implant in the nation using the FDA approved SAPIEN device. A smaller retroflex valve delivery system for TAVR was approved in June 2014 and often requires no surgical incision–it can be placed through a small puncture site in the groin.
For patients who have been deemed high or intermediate risk for traditional open-heart surgery, a procedure called transcatheter aortic valve replacement (TAVR) may be a treatment option. TAVR allows the aortic valve to be replaced, and like open-heart surgery, TAVR produces results in improving patients’ quality of life and lifespan. Patients with a history of stroke, prior chest radiation, prior open-heart surgery, COPD, frailty, renal insufficiency, advanced age, and other conditions may be appropriate for TAVR.
Patients may live with aortic stenosis for many years during a latent asymptomatic period that precedes the point that symptoms of the disease develop. However, after patients begin experiencing symptoms, prompt treatment becomes necessary.
Once symptoms appear, untreated patients have a poor prognosis. Patients with severe aortic stenosis have an increased risk of death from approximately 25% at one year and 50% at two years following onset of symptoms.
Some of the advantages of TAVR include shorter hospital stays and quicker recovery times. In addition, many TAVR procedures are done under sedation instead of general anesthesia.
As with any procedure, there are a few risks. Some of the risks for TAVR include bleeding at the catheter insertion site, vascular damage, infection, abnormal heart rhythms, and stroke. These and other risks will be discussed during the screening process.
The TAVR screening process utilizes a patient-focused approach. Our interdisciplinary team represents a strong partnership between cardiac surgery, interventional cardiology, cardiac nurses, cardiac imaging specialists, and our valve coordinator to offer our patients the highest level of expertise and care. Not only will the patient meet with an interventional cardiologist, but they will see two separate surgeons to help determine the right approach. CHI Memorial’s interdisciplinary heart team meets weekly to review cases and plan the best approach for each patient.
The screening process for TAVR is extensive, and includes a complete medical history, an EKG, and an echocardiogram. If the patient is deemed to be a good candidate for surgery or TAVR, cardiac catheterization is performed to exclude significant coronary artery disease. A CT of the chest is performed to evaluate the anatomy of the heart.
Other tests may include a CT of the abdomen and pelvis, a chest x-ray, ultrasound of the arteries in the neck, and pulmonary function studies. Additional studies may be ordered by the physicians based on an individual’s specific conditions.
Typically a patient will spend about one to five days in the hospital, depending on the approach used in the TAVR procedure.
Each patient receives detailed instructions after the procedure to ensure a full recovery. They are encouraged to stay active during the recovery process. While on pain medication, patients are discouraged from driving or operating heavy machinery.