As we age, the aortic valve can progressively narrow – this is referred to as aortic stenosis. This narrowing can cause symptoms that impact a person’s quality of life. Patients may have trouble performing tasks like grocery shopping or gardening, traveling or spending time with family. And once symptoms develop, the risk of death increases, too.
It is estimated that more than 2.5 million Americans over the age of 75 have aortic stenosis and 250,000 new cases are diagnosed annually.
Some patients require open heart surgery to replace the aortic valve. But some patients need a less-invasive option. And that’s where the transcatheter aortic replacement – or TAVR – comes in. The procedure is done in a cath lab setting and the patient’s new valve is inserted into the heart through a catheter inserted through the femoral artery.
Not every hospital can offer TAVR procedures. Instead, hospitals performing the procedures must meet several benchmarks:
- 50 surgical heat valve replacement performed in the prior year with a least 10 on high-risk patients.
- Two cardiovascular surgeons on medical staff.
- At least 1,000 heart caths performed in the prior year.
- At least 400 Percutaneous Coronary Interventions (PCI) performed in the prior year, which is the placement of stents and balloons to open arteries.
Physicians must also meet several standards, such as:
- Surgeons must perform 25 surgical heart valve replacements in the prior year.
- Cardiologists have experience in structural heart disease with 100 corrective procedures performed in their career.
TAVR patients benefit from the expertise of imagining specialists (radiologic technologists), heart failure specialists, cardiac anesthesia, intensivists, nurses and social workers.
What is Aortic Stenosis?
The aortic valve is a three-leaflet valve and is the major valve between the heart and the aorta (the big blood vessel that takes blood to the body). The north part of the aorta goes up and brings blood and oxygen to the head and the brain. Then the aorta comes down and feeds the rest of the body. The aortic valve is meant to prevent backflow. When the heart pumps, the valve opens to let the blood out and then closes. As people get older, calcium may build up on the aortic valve’s leaflets and the valve may not open all the way. This makes the heart work extremely hard. This can cause a shortage of blood to your organs. Aortic stenosis does not always cause symptoms, but as it progresses, symptoms can appear, such as:
- Shortness of breath
- Extreme fatigue
- Chest pain
- Inability to complete daily activities
Is TAVR right for me?
Aortic valve replacement is recommended for patients with severe aortic stenosis. Traditionally, this procedure required open heart surgery. But open heart surgery is often too risky for patients over 70 years old or patients with conditions such as diabetes or COPD. With the success of clinical trials, we now use the TAVR method for younger and healthier patients, too. The benefits of this procedure include faster recovery, less pain and fewer complications.
Patients undergoing the TAVR procedure will be under general anesthesia.
As with any procedure, there are risks that should be discussed with your physician. Be sure to speak with your TAVR hospital team so you can make an informed decision about your treatment plan.
What should I expect during TAVR recovery?
When expertly diagnosed and treated, patients with aortic valve disease can experience an improved quality of life and possibly a longer life. Patients with severe aortic stenosis can expect an improvement in symptoms. Many patients are able to return to a normal lifestyle after an aortic valve replacement procedure.
After the procedure, patients can expect to be in the hospital for 3-5 days. Many can resume normal activity in about 10 days. Your TAVR team will give you specific instructions, but care often includes:
- A phone call from your TAVR hospital care team a few days after discharge to check on your symptoms, medications and health.
- A follow up office visit with your TAVR doctor within 30 days of the procedure. This visit will likely include an echocardiogram to check your new valve. Other tests may also be ordered.
- From there your general cardiologist or primary care physician will develop a follow up care plan to fit your needs. You should be checked by your cardiologist annually.