TAVR

A Close Look at a TAVR (Transcatheter Aortic Valve Replacement)

The aortic valve is one of the most critical structures within the heart. Its purpose is to pump blood from the heart to the rest of the body. In the event that the aortic valve becomes stiff or narrowed, serious and even deadly consequences (such as heart failure) can occur. One effective way to treat such a scenario involves a transcatheter aortic valve replacement (often referred to as a TAVR). What does this procedure involve and what are the potential benefits?

What is a TAVR?

A TAVR involves the use of a catheter which guides an aortic replacement valve to the heart. The old valve is removed and the new one will be surgically implanted, the ultimate goal being to restore the heart to previous levels of functionality.

As the acronym suggests, a TAVR will employ a catheter and a log tube in order to reach the heart. An incision is made at the site of the femoral artery and close to the groin. This is known as a percutaneous procedure, as the heart will be indirectly accessed as opposed to traditional methods such as open heart surgery. Note that the patient will be placed under general anaesthetic or a strong sedative (depending upon the individual) and physicians will constantly monitor important metrics such as blood oxygen levels, respiration and heart rate.

Once the valve has been put into place, it will be briefly monitored to ensure that it is functioning properly. The catheter is thereafter removed before subsequently suturing the femoral artery closed. In most cases, cardiac function will be further examined through the use of a diagnostic technique known as transthoracic echocardiography.

How Will a Patient Prepare for a TAVR?

Blood tests, CT scans and x-rays will generally be performed before the procedure. These are used to evaluate the overall health of the patient. Some guidelines which should be followed leading up to the day of the surgery include:

• Quitting smoking (smoking can increase the chances of encountering pulmonary problems during a TAVR).
• Informing the specialist about any medications that are currently being taken (even over-the-counter substances).
• Eliminating specific medications as per the advice of a professional.
• Refraining from eating or drinking (normally the day before the surgery).

Those with specific health problems may be provided with further instructions.

What Happens After a TAVR Procedure?

The majority of TAVR procedures will take between three and four hours (including the installation of the replacement aortic valve). Once surgery has ended, the patient will be taken to an area of the hospital designated for cardiac recovery. Any sedatives or anaesthesia that had been administered will soon begin to wear off.

Due to the nature of the surgery, patients can normally begin to stand up and move around. However, this depends upon pain, age and other possible health issues that may be present. In most cases, the individual will be required to stay overnight in a hospital before returning home the following day.

There are also some important follow-up steps which could need to be taken. Wound care, taking certain pain medications and prescriptions designed to quicken TAVR healing times may be needed. Most patients will require several weeks to fully heal. Here are some other common recommendations that are likely to be mentioned:

• Walk around as much as possible without experiencing a massive amount of discomfort.
• Enrol in a cardiac rehabilitation programme.
• Resume normal daily activities but do not lift heavy objects.
• Monitor the site of the incision for redness or swelling.
• Call a doctor in the event that a fever is present.
• Quit smoking and embrace a healthy diet to avoid any further cardiac issues.

Patients should also feel free to ask any additional questions that they may have in order to better understand the procedure and subsequent follow-up recommendations.

What is the Difference Between a TAVR and a TAVI?

TAVI is an acronym which stands for transcatheter aortic valve implantation. Those who have heard this term will often wonder if it is different when compared to a TAVR procedure. It is important to note that both of these procedures as well as their diagnostic approaches are the same. Nomenclature is the only main disparity. This is why a cardiologist or structural heart specialist may use TAVR and TAVI interchangeably.

When Might a TAVR be Recommended?

One of the core principles of transcatheter aortic valve replacements involves their relatively non-invasive nature when dealing with a stenosis. Thus, they are often preferred when a patient presents with one or more specific underlying conditions. A handful of examples include (but may not be limited to):

• Age
• Compromised heart functionality
• A history of diabetes, kidney disease, liver disease or stroke
• COPD (chronic obstructive lung disease)
• A porcelain aorta (an aorta characterised by significant deposits of calcium)

A specialist may also choose to perform a TAVR in the event that the patient has had previous heart surgery (complications are less likely to occur).

What Benefits Can TAVR Surgery Provide?

We have already seen that the major benefit of a TAVR involves how the procedure is performed when compared to traditional methods such as open heart surgery. Thanks to this less-invasive procedure, healing times can also be decreased. Patients may therefore begin returning to their normal lives sooner as opposed to later.

Another advantage directly attributed to a transcatheter aortic valve replacement involves the imaging technology that will be used. Thanks to modern and cutting-edge software solutions, a structural heart specialist will be provided with an extremely accurate three-dimensional image of the damaged aorta and the surrounding tissues. He or she can then determine how the procedure will be performed while better appreciating the intended orientation of the replacement aorta. Of course, accurate imaging likewise helps to reduce the chances of complications before, during and immediately following the procedure.

It should also be mentioned that patients who are scheduled for a TAVR are generally less nervous. This is important from a psychological point of view. Furthermore, less time will need to be spent in hospital within post-operative settings. This enables the individual to quickly return to his or her normal activities; potentially advantageous in terms of speeding up the healing process.

Are There Any TAVR Risks to Consider?

It should still be made clear that much like any surgical procedure, there are some risks attributed to transcatheter aortic valve replacements. Some of these include:

• Damage to nearby blood vessels due to the presence of the catheter during the implantation process.
• Excessive bleeding
• Stroke due to a decreased amount of oxygen in the brain
• Heart attack
• Fluid may begin to collect around the heart
• Heart failure

Please note that TAVRs are now considered to be the dominant form of aortic valve replacement due to fact that the risks mentioned above tend to be rather rare. It is still important to speak with a physician to discuss your options and to highlight any concerns that you may have.

How Long Will an Aortic Replacement Valve Last?

Modern medical studies suggest that a typical TAVR aortic replacement valve will continue functioning properly for between 10 and 20 years. A further procedure may then be warranted. However, this also depends upon additional factors such as overall health, diet and lifestyle.

TAVR: A Highly Effective Treatment for Aortic Stenoses

Transcatheter aortic valve replacements have become extremely popular options when mitigating the dangers associated with an aortic stenosis. The non-invasive nature of these approaches is also ideally suited for patients who may be suffering from underlying health problems. The risk factors are generally low and most prognoses are positive. Those who wish to learn more are encouraged to speak with their physician or a cardiac care specialist.