Transcatheter Aortic Valve Replacement (TAVR)

TAVR in contentAortic stenosis is one of the most common and serious of heart valve diseases. When the aortic valve is unable to open wide enough to allow adequate blood flow from the left ventricle to the body, the heart must work harder to compensate. If this happens for a long enough time, the subsequent changes from the added workload can literally wear the heart out. 

Approximately 2.5 million people living in the United States 75 years or older have aortic stenosis. After the onset of symptoms and without an aortic valve replacement, patients with severe aortic stenosis have a survival rate as low as 50 percent at two years and 20 percent at five years. 

Until recently, surgical aortic valve replacement or SAVR was the only treatment option for severe aortic stenosis. SAVR is an open-chest procedure that involves a sternotomy, which is a six-to-eight inch incision through the breastbone used to open the chest wall and reach the heart. The patient’s heartbeat is temporarily stopped, and a heart-lung bypass machine keeps oxygen-rich blood circulating in the body. This provides the cardiothoracic surgeon full access to the inside of the chest cavity; it also allows the diseased valve to be removed and replaced while the heart is quiet and at rest. However, many patients with severe aortic stenosis have other medical conditions that keep them from being good surgical candidates. 

In 2014, Premier Health’s structural heart team was proud to be the first in Dayton to introduced another option called transcatheter aortic valve replacement or (TAVR). As its name implies, TAVR technology is a catheter-based intervention that can deliver and position a fully expandable, bioprosthetic replacement aortic valve while the heart is still beating. TAVR eliminates the need for a long incision in the chest wall, makes the use of a heart-lung bypass machine unnecessary, and provides a shorter, more comfortable recovery period when compared to a surgical replacement. 

Originally, the US Food and Drug AdministrationOff Site Icon (FDA) approved TAVR for patients with severe, symptomatic aortic stenosis who were at high or prohibitive open-chest surgical risk. Historically, such patients often refused or were denied surgery. 

In 2016, TAVR was approved by the FDA for an expanded indication, and now includes those patients at intermediate-surgical risk, allowing Premier Health to offer more patients new hope for an improved quality of life. 

Aortic Stenosis

Heart  Valves in contentAortic stenosis is the narrowing of the heart valve between the left ventricle and the aorta, which is the body’s largest artery. This is often caused by the build-up of cholesterol and other sticky substances that can harden into atherosclerotic plaque on the valve’s three leaflets. Aortic stenosis can also be caused by a congenital heart defect, rheumatic fever, or radiation therapy to the chest. 

Normal, healthy leaflets are flaps of tissue that easily open and close with each heartbeat. They regulate blood flow in one direction from the heart to the body. When the aortic valve cannot fully open, less oxygen-rich blood flows to where the body needs it. A stiff, non-flexible, and narrow aortic valve forces the heart to work harder to pump blood forward. Aortic stenosis is a progressive disease – making symptoms more severe and complications more likely with aging. Once symptoms develop, untreated aortic stenosis is life-threatening. 

The signs and symptoms of aortic valve stenosis include chest pain, lightheadedness, dizziness, fatigue, and shortness of breath. Eventually, severe aortic stenosis can cause the heart to get weaker, and increases the risks of heart failure, sudden cardiac arrest, and death. 

To learn more about what happens when the aortic valve is too tight, watch physician videos of Premier Health cardiologists answering common questions about aortic stenosis. 

Understanding Transcatheter Aortic Valve Replacement (TAVR) 

catheter insertion in contentTAVR can be an effective treatment option to improve the quality of life for patients with severe aortic stenosis, who otherwise may have limited treatment choices. Our structural heart team includes Premier Health specialists from cardiology, surgery, advanced medical imaging, and anesthesiology. While our TAVR team of physicians also practice at Premier Health hospitals from across Southwest Ohio, this catheter-based therapy is performed at Miami Valley Hospital.

Patients who are being considered for TAVR undergo a detailed clinical evaluation that includes a complete medical history, physical exam, assessment of signs and symptoms, and advanced diagnostic imaging studies. TAVR team members review the information and discuss treatment options, risks, and benefits with our patients and their families. Through shared decision-making, individualized plans of care are developed to optimize successful outcomes. 

As its name implies, TAVR technology uses a catheter designed to carry an expandable, bioprosthetic aortic replacement valve. Our team is trained and experienced in performing TAVR using a variety of approaches. 

  • Transfemoral: A small incision is made in the groin, and entry into the circulatory system is through the femoral artery. This is the approach used most often. 
  • Subclavian: A small incision is made in the upper chest near the collar bone and entry into the circulatory system is through the subclavian artery. 
  • Transaortic: A small incision is made in the upper chest to access the diseased aortic valve.
  • Transapical: Uses a small incision between the ribs to access the lowest part of the heart.

Assisted by advanced imaging techniques and technology, the team gently guides and places the device carrying catheter between the heart’s left ventricle and aorta. The natural, or in some cases, the current but poorly functioning bioprosthetic aortic valve, is not removed, but is used as an anchor for the TAVR valve. Once in place, the replacement valve is deployed, the catheter is gently guided out, and the TAVR procedure is finished. 

Watch the TAVR procedure in animationOff Site Icon.

TAVR Patient Benefits

Balloon TAVR graphicA TAVR intervention is not without risk, but it does provide beneficial treatment options to people who may not have been candidates for aortic valve replacement a few years ago. Often, patients will describe their experience with transcatheter aortic valve replacement as comparable to coronary angioplasty

  • An advanced practice provider will guide you and your family through pre-procedure testing, post-procedure care, and recovery.
  • TAVR can be performed using monitored anesthesia care (MAC) and generally takes less than two hours. 
  • Hospital stays vary, and many times depend upon our patient’s other medical conditions. 
  • Recovery from a surgical aortic valve replacement with an open-chest incision generally requires four to eight weeks. In most cases, TAVR can provide a shorter hospital stay with fewer complications, less discomfort, and a faster recovery. 
  • A replacement heart valve may help improve the quality of your life by easing the signs and symptoms of aortic stenosis such as pain or pressure in your chest, dizziness, shortness of breath, and extreme fatigue. 
  • After recovery, patients frequently return to regular activities with noticeable improvement. We ask our TAVR patients to please speak with their health care provider before starting any exercise program. 

Don’t Give Your Heart to Anyone. Trust Premier Health.

The Structural Heart Program’s innovative technologies and techniques are designed to provide quality care for positive patient outcomes — with fewer complications, shorter recoveries, and long-lasting benefits. We welcome patients seeking second opinions on their heart disease treatment options. 

If you or a loved one would like more information about the many services our Structural Heart Program offers, please call (937) 499-7427(937) 499-7427.

Content Updated: December 20, 2018

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