Patients diagnosed with aortic valve disease my be recommended to undergo a transcatheter aortic valve replacement (TAVR). This alternative procedure may be an option for those who are at a higher risk of complications from open-heart surgery. Certain types of transcatheter valves are FDA-approved for patients with low risk of major complications. TAVR is a minimally invasive procedure involving a thin tube called a catheter, which is inserted through an artery leading to the damaged valve. A new valve is then placed inside the diseased aortic valve. Some valve implants can expand independently, while others require a balloon. The expanded artificial valve will take over the function of regulating blood flow.

How Is a TAVR Procedure Performed?

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

During TAVR heart 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. Some valve implants can expand on their own, while others require a balloon. The expanded artificial valve will take over the function of regulating 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.
• Transcarotid: a minimally invasive approach via the artery in your neck.

An aortic valve replacement surgery may take up to 90 minutes to complete, while open-heart surgery may take up to 4 to 6 hours. The incisions made during the procedure are closed using alternative methods instead of traditional staples or stitches. TAVR patients may recover faster than they would after a traditional heart valve replacement surgery. Traditionally, TAVR patients require a one-night stay in the hospital.

Who Qualifies for TAVR Procedure?

Please ask your doctor if you qualify for a TAVR procedure. Often, patients with severe aortic stenosis may benefit from TAVR, which may also be referred to as transcatheter aortic valve implantation (TAVI). 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
• Fatigue
• Shortness of breath

The doctor will consider various health information, including medical history, lifestyle, test results and personal preferences, to evaluate a patient for surgical aortic valve replacement. Doctors decide if a patient qualifies for TAVR based on several factors such as severe aortic stenosis, symptoms like chest pain, fainting and irregular heartbeat, medications not improving symptoms and a preference for shorter recovery time. A shared decision-making approach is utilized once imaging is obtained. However, a patient might not be a good candidate for TAVR if their blood vessels and valves are not the right size for TAVR, their heart is too weak, they have untreated heart conditions or aortic problems, or they had a heart attack in the last 30 days or have an infection or severe illness.

What Is the Recovery Time for TAVR?

The incision from a TAVR procedure may take about two weeks to heal. Follow your doctor’s instructions for dressing, covering the wound and keeping it dry. 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

Antiplatelet therapy prevents 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. If you are a TAVR patient, here are some of the discharge instructions you can expect to receive:

• Maintain a heart-healthy, low-salt, 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

Can TAVR Be Done More Than Once?

Whether TAVR can be done more than once depends on several factors. This scenario, known as a "valve-in-valve" procedure, involves placing a new TAVR valve within a previously implanted TAVR valve that has failed or deteriorated. The feasibility of performing a repeat TAVR depends on the size and position of the first valve, its proximity to the coronary arteries and the angle of the aortic root. In cases where a second TAVR may not be feasible, surgical aortic valve replacement (SAVR) may be an alternative. The decision to proceed with another TAVR or switch to SAVR requires careful evaluation and planning by a multidisciplinary healthcare team to determine the appropriate approach for the patient. 

How Long Does a TAVR Valve Last?

A TAVR valve typically lasts between five to 10 years. Studies show that about 91% of patients do not experience significant valve issues, known as structural valve degeneration (SVD), during this time. SVD involves problems like the valve not opening or closing properly, which could lead to heart problems. While there is a very low chance (less than 1%) of severe valve problems within this period, about 1 in 12 patients might experience moderate issues. This information suggests that TAVR valves have good short- to medium-term durability, but how they perform beyond ten years is still being studied.

Find a Cardiologist in Rock Hill

Would you like to learn more about your risk for valvular heart disease or our TAVR procedure? At Piedmont Medical Center in Rock Hill, we have made it easier for you to take charge of your heart health and make important healthcare decisions.

Heart care is better together. Let us help you navigate your journey to a healthier heart. Please call or text our TAVR Coordinator (839-214-1447), call our Structural  Heart Coordinator (803-323-6982) or find a cardiologist near your location. If it's an emergency, such as a heart attack, cardiac arrest or stroke, please call 911 or go to the nearest emergency room. Please don't delay care.