What is TAVR?
Transcatheter Aortic Valve Replacement (TAVR), also known as Transcatheter Aortic Valve Replacement (TAVR), is a revolutionary, highly advanced, innovative new heart valve treatment most commonly used to treat patients whose aortic valve does not open well, due to which blood-flow out of the heart is reduced significantly (called Aortic Stenosis).
How is TAVR Performed?
Usually valve replacement requires an open heart surgery, in which the chest is surgically cut open for the procedure. However, TAVR involves a puncture though the skin into the blood vessels in the groin. A catheter, about the width of a pencil, is then inserted and threaded up through the blood vessels in the leg into the aorta (the main artery in the body) then into the heart. Through the tip of this thin catheter, a special valve is compressed and inserted into position. TAVR can be compared to an angiogram in terms of time and recovery as it requires a shorter hospital stay (average 3-5 days).
The TAVR procedure is also performed using a minimally invasive surgical method with a small incision in the chest and entering through a large artery or through the tip of the left ventricle, which is called Transapical approach.
Who is a candidate for TAVR?
The TAVR procedure is available for patients who are deemed inoperable by a heart surgeon for surgical replacement of the valve – those people for whom an open-heart procedure poses intermediate risk. For precisely this reason, most people who undergo this procedure are in their 60s – 80s and often have other medical conditions that make them a better candidate for TAVR. Potential candidates typically have one or more of the following characteristics:
- Advanced age
- Previous heart procedure/surgery
- Pulmonary hypertension
What are the potential benefits of TAVR?
In patients with severe Aortic Stenosis who are not candidates for surgery, TAVR is associated significantly improved survival, improved symptoms, and improved quality of life compared to standard treatment (open heart surgery). In fact, patients undergoing TAVR were nearly twice as likely to be alive at one year compared with those who did not.
What information is needed before the procedure?
Evaluation includes assessment of the aortic valve, peripheral vasculature, aortic calcification, coronary disease, hemodynamic, cardiac function, kidney function, lung function and frailty.
Who performs TAVR – Where should a candidate undergo the procedure?
As TAVR is a unique, advanced procedure, it requires a unique approach with a proactive, up-to-date heart team. The heart team includes cardiologists, cardiothoracic surgeon, imaging specialist and other specialists (pulmonologist, nephrologist, etc.) to work in combination. The procedural planning and selection including performance rely on these specialists working together. For this reason, TAVR should only be performed in a place with an established heart team with a strong cardiac surgery as well as cardiology programmes. Every part of the procedure is critical, including the pre-procedural selection and imaging, and all contribute to achieving a positive outcome. The stakes are high in a TAVR procedure. Having a heart team with TAVR experience is crucial.