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Transcatheter Aortic Valve Replacement (TAVR)

Overview

Transcatheter Aortic Valve Replacement (TAVR), sometimes also referred to as Transcatheter Aortic Valve Implantation (TAVI), is a newer, less invasive surgical procedure to treat aortic stenosis, narrowing of aortic valve opening. The procedure is to replace a narrowed or damaged aortic valve that does not open properly (aortic stenosis).

What is aortic stenosis?

The aortic valve is one of the four valves of the human heart. The narrowing of the aortic valve, resulting in the restricted opening, is called aortic stenosis. The occurrence of aortic stenosis restricts blood pumping out of our left ventricle into the aorta. The left heart chamber has to pump blood against the obstruction resulting in thickening of the heart muscle and ultimately dilatation of the heart chamber. The damage to the heart can result in heart failure and loss of life. The main causes of aortic stenosis are a birth defect, rheumatic fever, and degenerative process because of age. Aortic stenosis may not have noticeable symptoms in all cases.

Who is considered for TAVR?

Normally surgery is the treatment of choice for severe aortic stenosis. However, in some people, bypass surgery is not possible because of the previous cardiac surgery, old age or other health conditions like kidney failure, severe asthma. Such patients come into an intermediate or high-risk category.

TAVR may become an option for people with such intermediate or high risk of complications. Transcatheter aortic valve replacement may also be an option if one has an existing biological tissue valve that was previously surgically inserted to replace the aortic valve, but it is not functioning well anymore. The procedure is minimally invasive and the new valve is inserted via a tube through an artery in the thigh like coronary stenting.

The decision to perform Transcatheter aortic valve replacement to treat aortic stenosis is made after a multidisciplinary group of medical as well as surgical heart specialists are consulted who will together decide the best treatment option for an individual.

Transcatheter aortic valve replacement (TAVR) relieves signs and symptoms of aortic stenosis and improves survival in those who are at higher risk of surgical complications and those who cannot undergo surgery.

Signs and Symptoms

The common symptoms experienced are shortness of breath, chest pain, giddiness, fainting, and palpitations. It can be easily diagnosed by physical examination and echocardiogram. Once the patient is having symptomatic severe aortic stenosis, it reduces the longevity of life if left untreated. Asymptomatic, mild obstruction does not require treatment except periodic follow-ups.

How is TAVR performed?

A CT scan angiogram is the most important test done before transcatheter aortic valve replacement and is used to size the valve required, assess blockage in the heart arteries, and size of the leg artery from which the valve will be delivered. Transcatheter aortic valve replacement was performed for the first time in 2002 and more than 300,000 patients across the globe have been treated with this treatment option. The new valve is positioned inside the damaged valve. It starts functioning immediately. The procedure is done under anesthesia, conscious sedation or local anesthesia depending upon the medical requirement. The new valve has biological tissue leaflets and does not require anticoagulation. Patients undergoing transcatheter aortic valve replacement require a hospital stay of three to five days.

What are the Risks?

TAVR carries certain complications and risks, which may include:

  • Blood vessel problems
  • Bleeding
  • Stroke
  • Arrhythmias (heart rhythm abnormalities)
  • Heart attack
  • Kidney disease
  • Aortic coarctation
  • infection
  • Complications with the replacement valve like the valve leaking or slipping out of place
  • Death

Where is TAVR Available?

The procedure is available in few of the leading hospitals in India. A patient can contact a multi-disciplinary heart team in one of these hospitals for advice.

Conclusion

Transcatheter aortic valve replacement (TAVR) can improve the lives of people with aortic stenosis who cannot have surgery or for whom surgery is too risky. For these people, transcatheter aortic valve replacement can reduce the risk of death. Transcatheter aortic valve replacement may also relieve the signs and symptoms of aortic valve stenosis and improve overall health. Some studies have found that TAVR has similar mortality rates as heart valve surgery in people with aortic stenosis who have an intermediate or high risk of complications from open-heart surgery. The patient may need to continue taking certain medications after the procedure.

Healthy lifestyle changes like avoiding smoking, exercising regularly, eating a heart-healthy diet, and maintaining a healthy weight is also required post-procedure. Patients need to consult the doctor for a comprehensive cardiac rehabilitation program or a HeartHealthy Program following the procedure.

Explore Transcatheter Aortic Valve Replacement (TAVR) care at Apollo Hospitals.

 

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Verified By Dr A Sreenivas Kumar
MBBS, MD(Gen Med), DM(Cardio)SGPGI, FACC(USA), Consultant Cardiologist, Apollo Health City, Jubilee Hills
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