Transcatheter Aortic Valve Replacement
Brijeshwar Maini, MD, FACC
National Medical Director of Structural Heart and Transcatheter Therapies.
This revolutionary new heart procedure is an advanced minimally invasive treatment option for patients suffering from severe aortic stenosis. For some patients, traditional treatments such as open-heart surgery may not be an option.
However, there is new hope for patients with the TAVR procedure. TAVR has already helped thousands of patients with aortic stenosis return to the things they enjoy in life.
This minimally invasive surgical procedure repairs the valve without removing the old, damaged valve. Instead, it wedges a replacement valve into the aortic valve’s place. The surgery may be called a transcatheter aortic valve replacement (TAVR)
or transcatheter aortic valve implantation (TAVI).
Somewhat similar to a stent placed in an artery, the TAVR approach delivers a fully collapsible replacement valve to the valve site through a catheter. Once the new valve is expanded, it pushes the old valve leaflets out of the way and the tissue in the
replacement valve takes over the job of regulating blood flow.
How is TAVR or TAVI different from the standard valve replacement?
This procedure is fairly new and is FDA approved for people with symptomatic aortic stenosis who are considered a high-risk patient for standard valve replacement surgery.
The differences in the two procedures are significant.
What is involved in a TAVR procedure?
Usually valve replacement requires an open-heart procedure with a “sternotomy,” in which the chest is surgically separated (open) for the procedure. The TAVR procedure can be done through very
small openings that leave all the chest bones in place.
TAVR provides a beneficial treatment option to people who may not be candidates for traditional surgical intervention. A patient's experience with a TAVR procedure may be comparable to a balloon treatment or even an angiogramin in terms of down time and
recovery, and may require a shorter hospital stay (average 3-5 days).
The TAVR procedure is performed using one of two different approaches, allowing the cardiologist or surgeon to choose which one provides the best and safest way to access the valve:
- Entering through the femoral artery (large artery in the groin), called the transfemoral approach, which does not require a surgical incision in the chest
- Using a minimally invasive surgical approach with a small incision in the chest and entering through a large artery in the chest or through the tip of the left ventricle (the apex), which is known as the transapical approach.