Transcatheter aortic valve replacement, or TAVR, is a minimally invasive surgery that replaces a damaged valve in the heart. When a heart valve is damaged and left untreated, it can cause muscle damage, congestive heart failure or, in extreme cases, sudden death. Although a patient with heart valve issues may not notice symptoms right away, regular checkups can help identify any problems so preventive measures, such as TAVR, can be taken.
Michael Chang, MD, interventional cardiologist at Mercy Medical Group, a service of Dignity Health Medical Foundation, medical director of cardiovascular services at the Dignity Health Heart and Vascular Institute, and co-director of their TAVR program, said the procedure evolved as an alternative to cardiac surgery for aortic valve replacement. Historically, the primary surgical treatment for aortic stenosis was surgical aortic valve replacement (SAVR). During a SAVR procedure, surgeons remove the narrowed valve and replace it with a new one that's made of metal or tissue.
In TAVR, a catheter — a thin tube of medical-grade materials — is typically passed through the femoral artery in the groin. The femoral artery is your second-largest artery, which sends oxygen-rich blood to parts of the body and acts as your legs' main blood supply.
"Sometimes, we use a balloon to open up the valve, and then we deploy the TAVR inside the old, stenotic valve," Dr. Chang said. This means the surgery implants a normally functioning heart valve inside a narrowing heart valve without actually replacing it.
According to Dr. Chang, TAVR is a procedure for patients who aren't good candidates for open heart surgery, given the associated high risks and complications. The patient population for the procedure has gone from those who were high risk for cardiac surgery, to those with intermediate risk, and finally to low risk.
"The development of this therapy has been very rigorous, and has been very data-based," he said. "It was based on trials that initially randomized patients who were nonsurgical candidates for medical therapy or the TAVR valve." Patients who couldn't undergo surgery were treated with medication. Dr. Chang believes that the ongoing studies will finish by the end of 2017, with results becoming available in 2018.
Patients are seen by a structural heart team, and everyone has to agree that the patient is a candidate for the procedure, Dr. Chang said. The patient is seen by an interventional cardiologist and two cardiac surgeons, and then they get a full work-up that includes a CAT scan of the heart, abdomen, and pelvis to measure the size of the valve and artery.
The patient typically gets the CAT scan within one or two weeks, and then the procedure can be performed in about three weeks, Dr. Chang said. If everything goes well with the procedure, the recovery process typically lasts three to five days, but healthy patients can go home in one to two days.
With this minimally invasive option, people with heart valve issues have an opportunity for improved quality of life. If you or a loved one are having heart problems and seem like a candidate for this procedure, talk to your doctor.
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