Transcatheter Aortic Valve Replacement (TAVR): A New Hope for Heart Patients

The human heart has 4 valves that ensure that blood flows in the right direction at the right time. Malfunctioning valves can increase the risk of stroke, cardiac arrest, or heart failure. Thus, surgical interventions like valve replacement become important. Out of the four valves, mitral and aortic valves are the most commonly replaced.

Traditional surgeries often require a large incision leading to longer recovery time. In the case of a minimally invasive option like a transcatheter aortic valve replacement, you can expect faster recovery with less pain.

Let's find out more about transcatheter aortic valve replacement and the benefits it offers.

Transcatheter Aortic Valve Replacement (TAVR)- What it is? When is it used?

Transcatheter aortic valve replacement is a minimally invasive procedure that is used to replace a damaged aortic valve with an artificial valve. It is one of the most advanced options available for treating severe aortic stenosis.

Aortic stenosis is the narrowing of the aortic valve or the regions around it. This usually occurs because of age-related damage and the buildup of calcium in the valve. Since the valve becomes narrow, your heart has to work extra hard to pump blood to the rest of the body. This can cause long-term damage to the heart and even lead to heart failure. Thus, severe aortic valve stenosis needs the immediate attention of a cardiologist.

TAVR is usually recommended for patients when traditional or open-heart surgery can be too risky. Some of the factors that can necessitate choosing a TAVR over open heart surgery are:

• Old age
• History of heart surgery or stroke
• Diabetes
• Weak heart
• Chronic obstructive pulmonary disease
• Kidney disease, liver disease

A cardiac surgeon has to analyze several factors when deciding the type of aortic valve replacement to advise a patient. Your cardiac surgeon and interventional cardiologist should discuss TAVR in-depth with you for your clarity and understanding.

TAVR Versus SAVR for Aortic Stenosis

In recent times, TAVR has become popular because of the benefits it offers over surgical aortic valve replacement. Some of the advantages of TAVR are

• It leads to better outcomes as it is less invasive:  The current research and studies suggest that TAVR is less likely to cause complications like death for high-risk patients. There are also lower chances of stroke and a higher survival rate.
• Shorter stay at the hospital: Usually, heart surgeries require a long stay at the hospital. However, with TAVR, you can be released on the same or the next day of the procedure.
• Easy to recover: Patients find it easier to recover as there are lesser and smaller incisions. This allows easier recovery with less pain.

For years, SAVR was the standard treatment of choice. It involved creating a large incision across the chest to access the heart. Then, the defective valve was replaced.  However, with the advent of TAVR, such invasive procedures can be avoided.

Evolution of TAVR

Earlier, surgical aortic valve replacement (SAVR) was the only effective treatment for aortic stenosis. It was being used commonly since the 1960s. However, TAVR  has a success rate of over 99% and is emerging as a promising approach for treating aortic valve stenosis in the case of “high-risk patients”. This allows the surgeons to replace the heart valve without actually cutting open the chest. These individuals are at a greater risk of complications of a major surgical procedure. Thus, TAVR is a viable option for them.

TAVR received FDA approval in 2014. The treatment has also received approval in countries like India. Thus, there are a  variety of affordable options worldwide for patients looking to undergo TAVR.

Also, in 2019, the FDA gave a green signal to TAVR for being used in the case of people who are at “low risk” of complications from the surgery. Thereby providing access to a less invasive treatment option for people with heart valve disease.

Transcatheter Aortic Valve Replacement(TAVR) Procedure- Know the Steps

Since TAVR is less invasive than open heart surgery, it is completed in 1-2 hours. Your cardiologist will determine if you should get general anesthesia or a mild sedative.

Preparing for TAVR: Steps you can follow

• You can talk to your cardiologist about the regular medicines you have been taking and ask if you can take them before your TAVR.
• Ask if you have to stop drinking or eating before the procedure.
• Ask all relevant questions about the procedure to your cardiologist

TAVR procedure

• You will receive general anesthesia or sedation before TAVR.
•  The doctor will make a small incision in the groin, the space between your ribs or the neck.
• Through this incision, the interventional cardiologist will then insert a flexible and thin tube called a catheter with the heart valve into your artery to the diseased valve. The cardiologist can easily view the images of the heart during the procedure.
• The replacement valve will be passed via the hollow catheter and then placed in the diseased aortic valve. Then, the balloon present at the tip of the catheter is inflated. This pushes the new valve in its place.
• Once the new valve is secured, the cardiologist will then remove the catheter and suture your incision.

After the procedure

You will be kept in the ICU for the night after the procedure. The healthcare team will monitor your recovery. Also, the length of time for which you have to stay in the hospital will be influenced by several factors. However, most patients are released on the next day of the procedure. Your healthcare team will also inform you about the different ways by which you can take care of your incisions after being discharged from the hospital.

Possible Downsides of a TAVR

Though clinical trials have ascertained that TAVR is safe, no procedure is risk-free. There can be some drawbacks to it that you should know about:

• Sometimes the blood may leak from the valve because the replacement valve was not big enough.
• A pacemaker may be needed if the valves open when being placed. This can affect the heart’s electrical system, making a pacemaker necessary.
• Though reversible, the contrast dye that is used for imaging may hurt your kidneys in some cases.
• In a very small fraction of people, damage to the arteries has also been reported.

Not everyone can be a suitable candidate for TAVR, such as patients with endocarditis. Thus, you should check with your doctor if you are eligible for it.

Avail Heart Valve Replacement Surgery Across the World

Conclusion

Valve diseases like stenosis or regurgitation can significantly affect your quality of life. You may need valve replacement surgery to rectify the issue. However, if you are a valve disease patient then a transcatheter aortic valve replacement can be life-changing for you by providing faster recovery and less pain. This is an option you must explore by talking with your cardiologist.

Reference Links:

• https://www.mayoclinic.org/tests-procedures/transcatheter-aortic-valve-replacement/about/pac-20384698
• https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/understanding-your-heart-valve-treatment-options/what-is-tavr