Overview and Benefits
Transcatheter aortic valve replacement (TAVR) is a procedure used to treat a narrowed aortic valve. The aortic valve is one of the four valves of the human heart. It has three leaflets. These leaflets are opened to allow blood to push forward when the left ventricle contracts. They close between heartbeats to prevent the blood from flowing backward.
The aortic valve can become narrowed, thickened, and less flexible as a person gets older. When this happens, the valve will not fully open each time the ventricle contracts. As a result, the heart is forced to work harder in order to push blood through. Over time, this can strain the heart. This results in a number of symptoms. These include chest pains, shortness of breath, and dizziness. When not treated promptly, the condition can progress. It can cause the heart to fail. This is a life-threatening condition.
The condition is treated by replacing the diseased aortic valve. This procedure is often performed via open-heart surgery. This method requires an incision in the chest cavity to access and replace the diseased valve. TAVR is an option to open-heart surgery. It is less invasive and only requires small incisions. However, not all patients qualify for it. Patients who are eligible for this procedure are those who are not well enough to withstand open-heart surgery. It can also be an option for patients with certain medical conditions.
Who Should Undergo and Expected Results
Many patients with a narrowed aortic valve prefer TAVR over open-heart surgery. This is because it minimises the many risks of open-heart surgery. However, TAVR is only an option for those who meet certain criteria. These include extremely elderly patients (80 years and older) and those who are not physically strong enough to undergo open-heart surgery.
Before TAVR is even recommended, patients are assessed by a multidisciplinary team of specialists to determine their eligibility.
It is important to note that not all patients with a stenotic aortic valve have to undergo a surgical procedure. Those with mild to moderate cases and do not show symptoms of the condition may not require treatment. The progression of the disease can be delayed in most cases by living a healthy lifestyle.
The procedure can restore normal blood flow to the heart. Because of this, patients are relieved of their symptoms. Their quality of life is also expected to improve significantly. In addition, their risk of heart failure will be greatly minimised.
How is the Procedure Performed?
There are two methods on how TAVR is performed. Their main difference is the location of the incision. The incision can be made in the groin (transfemoral approach) or chest area (transapical approach).
Transfemoral means passing through the femoral artery. This artery can be accessed through the groin. In this procedure, the surgeon creates an opening in the groin and inserts an introducer sheath into the femoral artery. A flexible guidewire is then inserted through the sheath and advanced to the aorta and the left ventricle. The guidewire is then used to pass a catheter through the aortic valve. This catheter has a small balloon on its tip. When inflated, this balloon can make the aortic valve wider. Another catheter is then used to place the replacement valve. A stent is used to support the valve.
The second method is called transapical approach. It requires an incision in the chest (between the ribs) to access the lowest part of the heart. It then follows the same steps explained above. Both approaches are carried out under general anaesthesia. Both also use a special type of x-ray that surgeons use as their guide throughout the procedure. During the surgery, the patient’s surgical team closely monitors their heart function and rhythm. Any changes in heart function are managed as needed during the procedure. After the surgery, the incisions are closed with stitches. Patients are then given antibiotics to prevent infection from occurring.
Patients are then transferred to the hospital’s intensive care unit. They are closely monitored for possible complications. Many patients stay in the hospital between three and five days.
It is important for patients to adopt a healthy lifestyle following surgery. They are advised to watch what they eat. They must also do certain exercises approved by their doctor on a regular basis. They are also advised against smoking and drinking too much alcohol. It is also important that they maintain a healthy weight.
Potential Risks and Complications
Although less invasive than open-heart surgery, TAVR has risks of complications. These include damage to blood vessels and severe bleeding. The list of possible risks also includes stroke and heart attack. Patients may also develop arrhythmias, infections, and kidney disease. In most severe cases, it can cause death.
Nishimura RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. The Journal of Thoracic and Cardiovascular Surgery. 2014;148:e1.
Mack MJ, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): A randomised controlled trial. The Lancet. 2015;385:2477.