Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure that enables a collapsible aortic heart valve to be placed inside the heart. During the procedure, the TAVR device is crimped down and placed into the body via a catheter that is inserted in the upper thigh or groin. Once it’s delivered to the site of the patient’s diseased valve, the device is expanded with a balloon and begins to work immediately.
TAVR offers some patients the potential of a longer, better quality life. When TAVR was first introduced, it was only approved for patients who were not candidates for traditional open-heart surgery. Changes to the requirements now mean that patients with valve disease who are deemed high or intermediate risk may also be appropriate.
To assess whether someone is a candidate for TAVR, patients with severe aortic valve disease are screened in Trinity Health System’s Heart Valve Program. This program is directed by a team of specially trained cardiovascular surgeons, interventional cardiologists, and imaging cardiologists who review possible candidates to determine if TAVR is the best course of treatment for each individual patient.
Who Should Have TAVR?
For patients who have been deemed high or intermediate risk for traditional open-heart surgery, a procedure called transcatheter aortic valve replacement (TAVR) may be a treatment option. TAVR allows the aortic valve to be replaced, and like open-heart surgery, TAVR produces results in improving patients’ quality of life and lifespan. Patients with a history of stroke, prior chest radiation, prior open-heart surgery, COPD, frailty, renal insufficiency, advanced age, and other conditions may be appropriate for TAVR.
What happens if I do not receive aortic valve replacement?
Patients may live with aortic stenosis for many years during a latent asymptomatic period that precedes the point that symptoms of the disease develop. However, after patients begin experiencing symptoms, prompt treatment becomes necessary.
Once symptoms appear, untreated patients have a poor prognosis. Patients with severe aortic stenosis have an increased risk of death from approximately 25% at one year and 50% at two years following onset of symptoms.
What are the advantages of TAVR over open-heart surgery?
What is the usual work-up for TAVR?
The TAVR screening process utilizes a patient-focused approach. Our interdisciplinary team represents a strong partnership between cardiac surgery, interventional cardiology, cardiac nurses, cardiac imaging specialists, and our valve coordinator to offer our patients the highest level of expertise and care. Not only will the patient meet with an interventional cardiologist, but they will see two separate surgeons to help determine the right approach. Trinity Health System’s interdisciplinary heart team meets weekly to review cases and plan the best approach for each patient.
The screening process for TAVR is extensive, and includes a complete medical history, an EKG, and an echocardiogram. If the patient is deemed to be a good candidate for surgery or TAVR, cardiac catheterization is performed to exclude significant coronary artery disease. A CT of the chest is performed to evaluate the anatomy of the heart.
Other tests may include a CT of the abdomen and pelvis, a chest x-ray, ultrasound of the arteries in the neck, and pulmonary function studies. Additional studies may be ordered by the physicians based on an individual’s specific conditions.