Transcatheter Aortic Valve Replacement (TAVR) for severe aortic valve stenosis

At a Glance:

What is TAVR or TAVI?

Transcatheter Aortic Valve Replacement (TAVR) or implantation (TAVI) is a minimally invasive heart procedure to repair the aortic valve by wedging it with a replacement valve. It is a catheter-based procedure which is performed by the interventional cardiologist and cardiac surgeon for patients with calcified, narrowed aortic valve (aortic valve stenosis).

Why TAVR?

Transcatheter Aortic Valve Replacement (TAVR) is used for patients with aortic stenosis, who are very weak and cannot tolerate a major heart surgery. TAVR is a novel procedure which is well tolerated by many patients for whom an open heart surgery is considered to be risky.

High-risk aortic stenosis repair with TAVR

TAVR is indicated for a patient with intermediate or high-risk for complications related to surgical aortic valve replacement. This helps avoid surgical complications due to:

• Old age
• Previous heart surgery
• Kidney disease
• Lung disease
• Diabetes
• Calcified aorta

Aortic valve stenosis is a condition wherein the valve is not able to open and close completely. As a result the blood flow along the chambers is obstructed and the heart experiences extra strain to perform the otherwise normal function of pumping the blood out to the body. Thus, the patient begins to experience breathlessness, swollen ankles, chest pain, dizziness, and blackout episodes. Aortic valve replacement is therefore important to treat the patient completely of the valve defects and associated symptoms.

How is TAVR different from surgical valve replacement?

Transcatheter Aortic Valve Replacement (TAVR) is a catheter-based interventional method of repairing the stenosed aortici valve. It does not require opening of the sternum and chest to access the heart as in open surgery. Catheter is a long narrow tube that is used to implant a transcatheter aortic valve over a damaged valve. Transcatheter aortic valve is a specialized prosthetic valve that is different from the ones used in open surgery. The natural tissue from the pig or cow is attached around a flexible expandable mesh frame.

In the procedure, the cardiologist inserts or squeezes the valve along the catheter. Then, he makes a small incision in the groin, leg or chest to insert and guide the transcatheter aortic valve (TAV) in the heart and implants it over the existing valve. After the implantation, he removes the catheter and ensures the valve is working the right way.  This novel, interventional procedure is undertaken in the Cardiac Catheterization Lab (Cath-lab) where procedures like coronary angioplasty are regularly performed. Since these procedures are performed through small openings, the recovery is quicker than that from open heart surgery. The patient is monitored for at least next 24 hours in intensive care unit.

Benefits of TAVR over open surgery:

• It is a minimally invasive procedure that can be performed in the cath lab.
• No big scar after the procedure.
• Shorter hospital stay of 3-4 days.
• Return to normal life soon after discharge.
• Lower risk for patients with serious health conditions.

Thus, TAVI procedure risks are minimal and patients can recover quickly without any postoperative side-effects. 

TAVR – What to expect

Before procedure: If you are diagnosed with aortic stenosis, your eligibility for TAVR and its benefits are evaluated using following tests

1. Electrocardiogram
2. Echocardiogram
3. CT scan
4. Angiogram

TAVR coordinator may get in touch with you and your family to plan the procedure and guide you through preparation and aftercare. Patients with valve replacement are at an increased risk for developing infection of the heart valve and surrounding tissue (endocarditis). So, your doctor may advise antibiotics before the procedure.

On the day of procedure: You will be asked to sign a consent form once you get admitted in hospital. You will be moved to cath lab (Cardiac Catheterization lab) on the day of the procedure. The procedure will be performed under general anaesthesia and you will not feel any pain. At Yashoda Hospitals, TAVR is performed by a specialized team of interventional cardiologist, cardiac surgeon, cardiac anaesthetist under ultrasound and X-ray guidance.

After procedure: After the procedure, you will be monitored in the ICU until you are stable. Later you will be moved to the ward and prepared for discharge after full recovery which usually may take 5 to 10 days. You will be instructed about the use of blood-thinning medicines, diet & exercise. Regular follow-ups with the doctors to address any unusual problems (if any) help in faster & uneventful recovery.

Care after TAVR: Examine the insertion site everyday with clean, washed hands. Slight redness and tenderness with clear drainage is normal. Call your doctor or TAVI coordinator immediately if you notice:

• A lump that is getting bigger
• Any area of redness or warmth
• Pus or drainage

Also, if you notice:

• Fever or flu-like symptoms
• Pain or discomfort in the groin
• Pain or chest pain or breathlessness

Contact the emergency if you experience:

• Shortness of breath or chest pain that remains unrelieved.
• Breathlessness even at rest

Needing to sit on chair to sleep

TAVR at Yashoda Hospitals

Yashoda Hospitals is one of the leading center of excellence for heart care in India, with three decades of healthcare presence. Our team in the Institute of Cardiology includes leading cardiac surgeons, cardiac anesthesiologists, cardiac radiologists, and interventional cardiologists who evaluate and treat each patient jointly. Interventional cardiologists and surgeons in the institute are trained in the advanced technologies such as TAVR and have extensive experience in performing the procedure. The institute features facilities and infrastructure that complements the expertise of our cardiologists to deliver optimal patient care in advanced, complex surgeries and procedures. To know more about heart surgery, request for a call back and we will call you and answer all your queries.

About Author –

Dr. V. Rajasekhar, Consultant Interventional Cardiologist, Yashoda Hospital, Hyderabad
MD, DM (Cardiology)