Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement (TAVR), also known as transcatheter aortic valve implantation (TAVI), is a less invasive alternative to traditional open-heart surgery for patients with severe aortic valve stenosis, a condition characterized by the narrowing of the aortic valve opening. During TAVR, a new artificial valve is inserted via a catheter and positioned within the diseased valve, restoring normal blood flow through the aorta.

Once again in 2024, UTHealth Houston’s TAVR program has received the highest rating (3-star) from the Society of Thoracic Surgeons/American College of Cardiology. Our program is the highest rated STS/ACC TAVR program in Houston.

Treatments

TAVR is primarily used to treat severe aortic valve stenosis in all patients with severe aortic stenosis (used to be high risk only, now low and intermediate surgical risk are included as well. It may also be considered for intermediate-risk patients in certain cases. The procedure provides an effective means of improving symptoms, reducing mortality rates, and enhancing overall quality of life for patients with aortic valve disease.

Before the procedure

Before undergoing TAVR, a comprehensive evaluation is conducted to assess the patient’s overall health and determine their suitability for the procedure. This evaluation may involve medical history review, physical examinations, blood tests, electrocardiogram (ECG), echocardiogram, and specialized CT scans of the heart. The patient’s surgical risk is assessed, and a multidisciplinary heart team evaluates the need for TAVR versus other treatment options.

During the procedure

The TAVR procedure is typically performed in a specialized cardiac catheterization laboratory or hybrid operating room. The general steps involved in the procedure include:

Anesthesia: While many places offer general anesthesia, out team offers conscious sedation to most to ensure comfort and safety throughout the procedure.
Incision and Catheter Insertion: Small incisions are made in the groin or chest area to gain access to the blood vessels. Catheters are inserted into the blood vessels and guided toward the aortic valve.
Valve Placement: Using real-time imaging techniques, the artificial valve is advanced through the catheter and positioned within the diseased aortic valve. The new valve is expanded, pushing aside the old valve leaflets and securing itself in place.
Valve Assessment and Function Testing: The healthcare team evaluates the position and function of the newly implanted valve, ensuring proper blood flow and minimal leakage.
Catheter Removal and Incision Closure: Once the valve is in place, the catheters are removed, and the incisions are closed using sutures or adhesive strips.

After the procedure

After TAVR, the patient is transferred to the recovery area for monitoring and observation. The vital signs, heart function, and oxygenation are continuously monitored. Pain management, medication administration, and fluid balance are carefully managed. The patient may require a short stay in the hospital before going home the next day.

Advantages

Minimally Invasive: TAVR is a minimally invasive procedure that avoids the need for traditional open-heart surgery, resulting in shorter recovery times and reduced hospital stays.
Suitable for High-Risk Patients: TAVR offers a treatment option for patients who are at high surgical risk or deemed inoperable for open-heart surgery.
Improved Quality of Life: TAVR effectively relieves symptoms associated with aortic valve stenosis, such as chest pain, shortness of breath, and fatigue, leading to an improved quality of life for patients.

Risks

While TAVR is generally safe and well-tolerated, there are potential risks and complications associated with the procedure, including:

Valve Dislodgment or Malposition: The implanted valve may become dislodged or incorrectly positioned, requiring additional intervention or conversion to open-heart surgery.
Vascular Complications: Damage to blood vessels during catheter insertion or removal can result in bleeding, hematoma, or vascular injury.
Stroke: The risk of stroke exists during the procedure due to the manipulation of catheters and the potential for dislodged debris to travel to the brain.
Valve Leakage or Blockage: Although rare, the new valve may experience leakage or blockage, necessitating further treatment or valve replacement.

Typical recovery time

The recovery time after TAVR varies depending on the individual patient and their overall health. However, compared to traditional open-heart surgery, TAVR typically involves a shorter hospital stay, usually a day. Patients may experience a quicker recovery, with a gradual return to normal activities within a few weeks.

Results and post-procedure care

TAVR has demonstrated excellent outcomes in terms of improving symptoms, reducing mortality rates, and enhancing the quality of life for patients with severe aortic valve stenosis. Following the procedure, post-procedure care may include:

Regular follow-up appointments with the healthcare team to monitor the functioning of the artificial valve and overall cardiac health.
Medication adherence, including prescribed medications to prevent infection, manage blood pressure, and prevent blood clots.
Cardiac rehabilitation programs to gradually increase physical activity and improve cardiovascular fitness.
Close monitoring for any signs of valve dysfunction, abnormal symptoms, or complications, and promptly seeking medical attention if any concerns arise.