Transcatheter aortic valve replacement (TAVR) is a minimally invasive valve replacement surgery for patients with severe or moderately severe aortic stenosis who are not candidates for traditional open heart surgery or those who are considered high-risk operable patients. Available at the Guthrie Cardiac & Vascular Center in Sayre, Pa., this advanced procedure allows the aortic valve to be placed while the patient’s heart is beating, no bypass machine is required.
Aortic stenosis is an obstruction of the flow of blood through the aortic valve caused by a narrowing of the valve due to calcium build up, cholesterol or defect. Aortic stenosis damages the heart by causing it to work harder due to the altered flow of blood.
Aortic stenosis can cause the following major symptoms:
- Fainting (syncope)
- Chest Pain (angina)
- Shortness of breath
Left untreated, severe aortic stenosis significantly decreases the average life expectancy of patients and approximately 50% of patients die within an average of 2 years.*
Transcatheter aortic valve replacement is sometimes called transcatheter aortic valve implantation (TAVI).
The TAVR Valve and Stent
TAVR surgery is performed with a transcatheter aortic heart valve which was FDA approved 2011. The valve, which comes in multiple sizes to fit the anatomy of the patient’s heart, is composed of a valve made of bovine (cow) pericardium and a balloon-expandable metal stent.
TAVR procedures takes place in Guthrie Robert Packer Hospital’s hybrid OR – a state-of-the-art operating room with real-time, high-resolution digital imaging capabilities allowing for complex surgeries and studies to take place simultaneously with an integrated team of heart and valve specialists.
The new aortic heart valve can be placed using a transfemoral or a transapical approach.
Transfemoral Approach – The Most Common Approach
A catheter is placed in the femoral artery through a small incision made at the patient’s groin and is then guided to the heart. The valve is then passed through a balloon catheter, positioned at the aortic valve and inflated in its final position.
For those patients whose femoral arteries may not be large enough to accommodate the catheter used in the transfemoral approach, the transapical approach is an alternative. With the transapical approach, the surgeon makes a small incision in the chest and guides the catheter between the patient’s ribs. Entry into the patient’s heart is made and the valve is then passed through a balloon catheter, positioned at the aortic valve and inflated in its final position.
Upon completion of the TAVR procedure, patients are typically transferred to the Intensive Care Unit (ICU) overnight and then spend two to five days recovering at Guthrie Robert Packer Hospital. More patients are discharged within two days.
Benefits of TAVR
Because general anesthesia is not required, many patients are able to stay awake during the procedure.
Because TAVR is a minimally invasive procedure that does not require cardiopulmonary bypass or open heart surgery, patients typically benefit by spending fewer days in the intensive care unit (ICU) and from a shorter hospital stay and a faster recovery period.
Who Is a Candidate For TAVR?
Any patient diagnosed with aortic stenosis can request a consultation at the Guthrie Heart Valve Clinic by calling 570-887-2289. At the Guthrie Heart Valve Clinic, patients will be evaluated by a team of heart and valve specialists who can determine the right treatment options to manage a patient’s aortic stenosis. Treatment options may include medical management, TAVR or other surgical interventions.
The goal of the team at the Guthrie Heart Valve Clinic is to recommend the treatment option that will provide each individual patient the best possible medical outcome.
Risks of TAVR
As with any surgical procedure, there are risks involved. Please consult with the Guthrie Heart Valve Clinic to learn more about the TAVR procedure and the associated risks.
*Lester, SJ, Heilbron, B, et al. The Natural History and Rate of Progression of Aortic Stenosis. Chest 1998; 113; 1109-1114
Images and video used with permission of Edwards Scientific