By Medicover Hospitals / 26 May 2021

Home | Procedures | Transcatheter Aortic Valve Replacement

By Dr A Sharath Reddy
Cardiologist & Endovascular Specialist

Article Context:

  1. Benefits of TAVR
  2. Difference Between TAVR and Open Heart Surgery
  3. Treatment Option
  4. Survival Rate of TAVR
  5. What is Aortic Stenosis?
  6. What Happens When Someone Has Aortic Stenosis?
  7. FAQ
  • TAVR (Transcatheter Aortic Valve Replacement) or sometimes called Transcatheter Aortic Valve Implantation (TAVI) is done when a person has suffered a heart attack or faced symptoms of a heart attack.
  • TAVI (sometimes called transcatheter aortic valve replacement or TAVR), is a less-invasive procedure than open-heart surgery. This procedure uses a catheter to implant a new valve within your diseased aortic valve. TAVI can be performed through multiple approaches. However, the most common approach is the transfemoral approach (through a small incision in the leg).
  • The use of less invasive procedures – particularly TAVI via transfemoral approach performed under conscious sedation and/or local anesthesia, may present an opportunity to minimize ICU and hospital stay - ESC Guidance for the Diagnosis and Management of CV Disease during the COVID-19 Pandemic
  • If the patient has mild to severe aortic stenosis, the goal is to regulate and lower cholesterol, maintain healthy blood pressure, exercise, and follow a strict diet while taking medication. If the condition is severe, the valve will harden even more and blood flow becomes very low, the patient may experience symptoms such as chest tightness, shortness of breath, and fainting. It can potentially cause heart failure and death from a heart attack. The doctor may recommend Transcatheter Aortic Valve Replacements or Open Heart Surgery to alleviate the symptoms and signs of Aortic Stenosis.
  • TAVR

    Benefits of TAVR

    Low Complication Rate:

  • TAVI Procedure has minimal risks of all causes and cardiovascular mortality, stroke, life-threatening bleeding, and major bleeding complications.
  • Fast Recovery Vs Surgery:

  • TAVR provides for a faster post-procedure discharge, including direct discharge to the patient's home.
  • Better Quality of Life:

  • When compared to surgical aortic valve replacements, TAVR improves the quality of life.
  • Alleviations of symptoms:

  • The majority of TAVR patients will become asymptomatic and more active in the years post-procedure.
  • Extended Life Expectancy:

  • Patients who have undergone TAVR have a greater rate of survival, even when they are classified as inoperable.
  • Observed Durability:

  • The partner trials have exhibited five years of outcomes, demonstrating continued durability and excellent hemodynamic performance.
  • Difference Between TAVR and Open Heart Surgery

    TAVR Open Heart Surgery
    The average TAVR procedure may take up to 1-2 hours and might take up to 8 hours, depending on the complexity. The average time for Open Heart Surgery is up to 4 hours.
    The recovery Time of TAVR is Less than 2-3 days to 1 week. Open heart surgery recovery time varies from 6 to 12 weeks, depending on the patient's health.
    TAVR cut is mere 4cms. A 6 - 8 inch incision is made to process the surgery.
    Skin infection is near zero as no bone is cut. Chances of having infection complications after cardiac surgery occurs in 5% to 21% of cases.
    Less anxiety and mental uneasiness. Might take a mental toll throughout the recovery process. (Only a few patients go through this)
    No bone is cut. Ribs are cut near the chest to proceed with the operation.

    Who Isn't Eligible for TAVR?

  • The TAVR valve should NOT be used for patients who:
    • Have an infection
    • Have a mechanical valve
    • Cannot take blood-thinning medicines
    • Have a reaction to some metals
    • Have a reaction to some imaging solutions

    Who is eligible for TAVR Procedure/ Operation?

  • If the patient had a Heart Attack or faced symptoms of heart attack and
    • Is sensitive to open-heart surgery
    • It has a high risk of surgical complications
    • Is conditioned to be suffering from kidney or lung diseases and cannot undergo invasive surgery
    • Have an existing valve that was previously inserted to replace the original aortic valve, but it isn’t functioning well anymore
  • The decision to treat aortic stenosis by TAVR procedure is made after following some tests prescribed by your doctor.
  • Treatment Option:

  • Treatment for aortic stenosis depends on how far your disease has progressed. If your stenosis is mild, medication may be prescribed to help regulate your heartbeat and prevent blood clots. However, if the severity of your stenosis progresses, your doctor may recommend replacing your diseased aortic valve. Severe aortic stenosis cannot be treated with medication. The only effective treatment is to replace your aortic valve.
  • Transcatheter Aortic Valve Implantation:

  • TAVI has emerged as an option for the treatment of inoperable patients with severe Aortic Stenosis (AS) following heart team assessment. Clinical characteristics and anatomy considered as contraindications for surgery include porcelain aorta, deleterious effects of chest-wall irradiation, oxygen-dependent respiratory insufficiency, and frailty.This less-invasive, beating heart procedure is commonly performed via transfemoral (TF) access, which requires no general anesthesia and reduces patient time in intensive care. Two other alternatives, the transapical (TA) or transaortic (TAo) approaches, can be used if TF access is not feasible due to anatomical contraindications.TAVI is also a therapeutic alternative in high and intermediate-risk patients considered suitable for surgery, but where TAVI is preferred based on individual risk profile assessed by a heart team. The PARTNER TRIAL (Placement of Aortic Transcatheter Valve Trial), large randomized studies using the Edwards SAPIEN valves, supported this established treatment option in symptomatic patients with severe Aortic stenosis.
  • What are the Tests Done Before TAVR Procedure?

  • If you have symptoms or had a heart attack, your doctor may recommend that you undergo certain tests, such as an echocardiogram or a CT Coronary Angiogram, to accurately assess your condition and confirm Aortic Stenosis.
  • Before TAVR Procedure:

  • The Specialty team will make sure you understand the precautions to take before and during the Transcatheter Aortic Valve Replacement (TAVR) procedure.
  • Before beginning the TAVR procedure, you may ask questions you have. Don't be hesitant to ask all your questions before the procedure.
  • Depending upon your condition and age, anesthesia will be given. You may be asked to join the hospital day before the TAVR procedure to follow up with the formalities.
  • To start the procedure, your doctor will prescribe anaesthesia by monitoring the heart rhythm and pulse. Then they inject a medication to prevent blood clots during the TAVR procedure.
  • A minor cut is made near the ribs or the groin or the neck and a small hollow tube called a catheter are positioned at a suitable place where the cut is made.
  • The catheter is moved carefully along the heart valve to the heart chamber where the aortic stenosis forms.
  • The doctor will then remove the tube and close the cut, after which the catheter with the TAVR implant will be placed.
  • The aortic valve that was replaced by a new valve should work well. Your doctor will ensure that your new valve is working fine before he closes the cut.
  • native-aortic-valve

    After The TAVR Procedure:

  • You may not need more rest as compared to other procedures. You may spend 1-2 days in the ICU followed by a hospital stay in the patient room for another 2-3 days.
  • Nearly all patients start walking in 1 day and are allowed to do small activities in 2-3 days of the procedure, under doctor surveillance.
  • Before you leave the hospital, you will be suggested to restrict some physical activities for a few more days depending on the condition and they will also advise when to re-visit the doctor after taking the TAVR procedure.
  • To monitor the condition after TAVR, you should have a TAVR check every 30 days to 1 year (as per the doctor’s suggestion). In case if you face any health changes and discomfort, make sure you visit the doctor.
  • The Survival Rate of TAVR:

  • The average survival rate of the TAVI procedure is a maximum of 16 years (from the past studies) for patients aged 65 or less. Although Open Heart Surgery is a very well known and most practised surgery in India, the procedure itself takes about 4 hours and a long recovery time.
  • Aortic Stenosis in COVID situation

    benefits-of-tavr

    What is Aortic Stenosis?

  • Aortic Stenosis is a build-up of calcium deposits on the valve, which causes the valve to narrow and reduce blood flow to the rest of your body.
  • As we age, our bodies go through many physical changes. You may not be able to climb stairs as easily. Or you may notice discomfort or inability to participate in normal daily activities. Sometimes changes in your physical health are a result of getting older. But sometimes, these changes may be signs and symptoms of an underlying medical condition, such as heart valve disease, a common condition in which the heart valves do not work the way they should.
  • Signs of Heart Valve Disease:

  • Heart valve disease can cause the blood flow from your heart to your body to be disrupted. If your body is not getting enough oxygen, this can lead to some of these typical symptoms:
    • Shortness of breath
    • Chest pain
    • Fatigue (low energy)
    • Lightheadedness, feeling dizzy, or fainting
    • Difficulty when exercising
    • Swollen ankles and feet
    • Rapid or irregular heartbeat
  • These symptoms can be a sign of a serious problem. It is important to talk to your doctor as soon as you experience symptoms, or if your symptoms worsen.
  • Main Causes of Heart Valve Disease:

  • Congenital Defect: The disease can be something you are born with, affecting the anatomy of the heart.
  • Family History: Sometimes heart valve disease is more common in certain families.
  • Infection or Inflammation: This can cause scar tissue to form in the heart and make it difficult for the valves to open and close properly.
  • Age: Our heart valve muscles can weaken or become damaged as we age, which is why older people are commonly diagnosed.
  • What Happens When Someone Has Aortic Stenosis?

  • Over time, the leaflets of your aortic valve become stiff, reducing their ability to fully open and close. When the leaflets don’t fully open, your heart must work harder to push blood through the aortic valve to your body. Eventually, your heart gets weaker, increasing the risk of heart failure (your heart cannot supply enough blood to your body).
    • Patients with severe aortic stenosis may find it hard to carry out normal activities, like walking to collect the post or climbing the stairs.
    • By the time it is found in many patients, the disease has progressed to an advanced stage. This is why doctors call it severe aortic stenosis. The aortic valve has a severe build-up of calcium and it struggles to open and close.
    • When this happens, your risk of heart failure increases significantly. The outlook for severe aortic stenosis is poor if left untreated.
  • Without treatment, survival rates in patients with severe aortic stenosis are as low as 50% at two years.
  • Aortic Stenosis doesn’t wait …

  • Many patients will die waiting for Aortic Valve Replacement Aortic stenosis is a common public health problem affecting millions of people around the world. It is estimated that up to 12.4 % of people over age 75 have aortic stenosis. About 80% of adults with symptomatic aortic stenosis are male.
  • Frequently Asked Questions:

    TAVI (sometimes called transcatheter aortic valve replacement or TAVR), is a less-invasive procedure than open-heart surgery. This procedure uses a catheter to implant a new valve within your diseased aortic valve.

    Any heart procedures comes with its own risks and complications. Considering the fact that TAVR procedure is most opted heart valve replacement surgery and is quickly becoming the new gold- standard for treating valve disease, researchers found that people in the TAVR group had significantly lower rates of death.

    A multicenter clinical trial has found that TAVR performed better than open-heart surgery in low-risk patients with severe aortic stenosis.

    TAVR is not as painful as any heart surgery, you many have aches and minor pains after the procedure. Which can be taken care of with the medication prescribed by the doctor.

    For few TAVR might only be an option as they cannot undergo any other surgical operations. Few are eligible for both TAVR and Open Heart Surgery and are comparatively choosing TAVR.

    Recently doctors noted that TAVR therapy is vastly developed in the last 10 years in INDIA and the number of valves replacements made are more than surgical approaches.

    Citations:

  • https://www.ottawaheart.ca/test-procedure/tavi-transcatheter-aortic-valve-implantation
  • https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/understanding-your-heart-valve-treatment-options/what-is-tavr