Transcatheter Aortic Valve Replacement (TAVR)

Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure to replace the aortic valve, which is the main valve that controls blood flow from the heart to the rest of the body. The procedure involves replacing the damaged or diseased valve with an artificial one through a small incision in the groin or chest.

Indications

TAVR is typically recommended for patients who have severe aortic stenosis, which is a narrowing of the aortic valve that can cause symptoms such as shortness of breath, chest pain, and fatigue. The procedure is usually considered for patients who are at high risk for surgical aortic valve replacement (SAVR) or inoperable due to other medical conditions.

Procedure

The TAVR procedure involves the following steps:

• A small incision is made in the groin or chest to access the femoral artery or another blood vessel.
• A catheter (a thin, flexible tube) is inserted through the incision and guided to the heart using imaging technology such as X-ray or ultrasound.
• The catheter is used to deploy a new valve, which is made of biological tissue (such as pig or cow tissue) or synthetic materials.
• The new valve is expanded to fit snugly within the diseased valve, and the catheter is removed.

Types of TAVR Valves

There are several types of TAVR valves available, including:

• Edwards SAPIEN valve: This is a balloon-expandable valve made from bovine pericardial tissue.
• Medtronic CoreValve: This is a self-expanding valve made from porcine pericardial tissue.
• St. Jude Portico valve: This is a self-expanding valve made from bovine pericardial tissue.

Risks and Complications

As with any medical procedure, TAVR carries risks and potential complications, including:

• Bleeding or hematoma at the access site
• Vascular complications, such as vascular injury or perforation
• Stroke or transient ischemic attack (TIA)
• Acute kidney injury
• Death

Benefits

TAVR has several benefits, including:

• Minimally invasive procedure with smaller incision compared to SAVR
• Faster recovery time compared to SAVR
• Reduced risk of complications compared to SAVR in high-risk patients
• Improved quality of life and reduced symptoms of aortic stenosis

Post-Procedure Care

After the TAVR procedure, patients typically require:

• Monitoring in an intensive care unit (ICU) for several hours or overnight
• Anti-coagulation therapy to prevent blood clots
• Pain management and medication to reduce discomfort
• Follow-up appointments with a cardiologist to monitor progress and adjust treatment as needed

Long-Term Outcomes

Studies have shown that TAVR can improve long-term outcomes for patients with severe aortic stenosis, including:

• Improved survival rates compared to medical therapy alone
• Reduced symptoms and improved quality of life
• Low rates of valve dysfunction or failure