What is TAVR?

TAVR is a less-invasive heart valve replacement procedure where a thin tube called a catheter is inserted through an artery leading to the damaged valve. A new valve will be placed inside the old 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.

Why is TAVR Needed?

Patients with severe aortic stenosis may benefit from TAVR, also known 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
• Fluttering or rapid heartbeat
• Trouble breathing
• Lightheadedness
• Swollen feet or ankles
• Difficulty sleeping
• Decline in activity level

Who Qualifies for TAVR Procedure?

TAVR is usually recommended for people who may not qualify for open heart surgery. A doctor may decide if a patient is qualified for TAVR if:

• They have severe aortic stenosis
• They experience chest pain, fainting, irregular heartbeat and other symptoms
• Medications have not improved their symptoms
• They prefer a shorter recovery time

A patient may not be a good candidate if:

• Their blood vessels and valve are not the right size for TAVR
• Their heart is too weak
• They have untreated heart conditions
• They have aortic problems
• They have had a heart attack in the last 30 days
• They have an infection or a severe illness

The doctor will consider many things when evaluating a patient for TAVR, such as medical history, lifestyle, test results and personal preferences.

What are the Benefits of TAVR Compared to Traditional Open-Heart Surgery?

As a minimally invasive procedure, TAVR offers several potential benefits compared to open-heart surgery.

These benefits may include:

• Less pain
• Lower risk of infection or complications
• Less trauma to the heart muscle and chest tissue
• Shorter hospital stays and recovery time

Before you qualify for TAVR, your heart care team will review your medical condition, assess the severity of your valve’s defect, determine treatment options and inform you and your family of the benefits and risks of these treatments.

What to Expect During TAVR

Before the procedure, the doctor will perform tests to ensure that TAVR is right for you, such as:

• Blood tests
• Electrocardiogram
• Echocardiogram
• Computer tomography (CT scan)
• Coronary angiogram

You will be asked 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, 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 procedure are:

Transfemoral: the surgeon accesses the damaged valve through the femoral artery instead of a chest surgical incision, which is more invasive.

Transapical: a minimally invasive procedure where a surgeon makes a small cut in the chest and enters the heart through its apex.

How Serious is TAVR Surgery?

The benefits of the TAVR heart procedure as a minimally invasive treatment procedure compared with aortic valve replacement surgery are:

• Lower risk of infection
• Less trauma to the heart muscle and chest tissue
• Shorter hospital stays and recovery time

Before you qualify for TAVR, your heartcare team will review your medical condition, assess the severity of your valve’s defect, determine treatment options and inform you and your family of the benefits and risks of these treatments.

How Long Does the TAVR Procedure Take?

An aortic valve replacement surgery may take up to 90 minutes to complete, while open-heart surgery may take up to four to six hours. TAVR patients may recover faster than they would after a traditional heart valve replacement surgery.

What is the Recovery Time for TAVR?

Wound from the TAVR catheter incision site may take about two weeks to heal. Follow your doctor’s instructions for dressing, covering the wound and keeping it dry. At the end of the two weeks, the doctor may need to remove the wound staples or stitches. Your incision site may remain bruised for a few weeks more. Contact your doctor if your wound is:

• Swollen or warm
• Draining excess fluid
• Bleeding
• 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

Antiplatelets prevent 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 to improve their survival. 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.

If you experience any of or a combination of the following symptoms, seek medical care:

• Chest pain
• Fever
• Nausea
• Shortness of breath
• Severe and persistent abdominal pain
• Swelling, redness or drainage from the surgical wound
• Vomiting

What Lifestyle Changes Do I Need to Make After TAVR?

Here are some lifestyle changes to help improve your health after TAVR:

• Quit smoking
• Consume a heart-healthy diet
• Keep your blood pressure in check
• Get at least 150 minutes of moderate-intensity physical activity per week

What are the Potential Long-Term Effects of TAVR?

TAVR is generally a safe procedure. Some patients may have an increased risk of some complications, such as:

• Replacement valve leak
• Complications related to major blood vessels
• Needing to have a pacemaker implant
• Requiring a second surgery
• Kidney damage
• Stroke

Your doctor will inform you of potential complications. Make sure to talk to your doctor if you experience any symptoms.

Does Insurance Cover TAVR?

TAVR is insurance-covered for purposes not expressly listed as an FDA-approved indication. The procedure must be performed within a clinical study fulfilling the conditions set by the Centers for Medicare & Medicaid Services. Talk to your doctor or insurance provider to learn more.