Transcatheter aortic valve replacement, or TAVR, is a minimally invasive heart procedure that replaces a thickened aortic valve that can't fully open (aortic stenosis). The procedure restores proper blood circulation by inserting a replacement valve into the damaged valve.
"With TAVR, you're essentially cured of aortic stenosis," says Jason Glotzbach, MD, a cardiothoracic surgeon at University of Utah Health. "The patient's life expectancy and quality of life goes up right away. And unless there are other issues, their prognosis from a heart standpoint is improved within a week or two."
The Aortic Valve and Stenosis
Aortic stenosis means narrowing of that valve opening, most often due to calcium buildup on the aortic valve's leaflets. These leaflets are flaps of tissue that regulate the flow of blood through the aortic valve. "Instead of nice, soft, pliable, elastic leaflets, they become calcified and stiff, barely opening," Glotzbach says. When blood cannot properly eject from the heart, increased stress on the pumping chamber of the heart causes symptoms.
Stenosis Risks and Diagnosis
"Patients usually have a heart murmur," Glotzbach says, "and the aortic stenosis murmur is one of the loudest, most classic murmurs in the heart. By the time you get moderate stenosis, the murmur is fairly prominent. A transthoracic echocardiogram is then used to confirm the diagnosis and determine the severity of stenosis."
Symptoms of severe aortic stenosis includes:
- Shortness of breath
- Fatigue with exertion
- Syncope—passing out with activity
- Chest pain
- Sudden death
"Stenosis is a common cause of passing out," Glotzbach says, "because if the aortic valve gets tight enough, you literally can't get enough blood out to your brain to maintain consciousness."
Intervention Before Failure
"When we see severe echo measurements in a patient with symptoms, we usually recommend aortic valve replacement," Glotzbach advises. "In the last decade or so, we've developed and rapidly adopted the transcatheter aortic valve replacement procedure—a completely different technique than the standard approach." TAVR patients typically go home the next day.
"There are risks with the procedure, but without treatment, half of those with severe stenosis will die within two years," Glotzbach says. "Unfortunately, there are no medications, diet, lifestyle, or exercise regimens that can treat aortic stenosis."
TAVR Surgery and Benefits
TAVR is not open-heart surgery. Instead, the new valve is crimped down on a special delivery device. "We insert that device through the femoral artery in the groin, using live x-ray as a guide," Glotzbach explains. "There's much less recovery time"—one week compared to six to eight weeks—because there's no sternotomy incision, and the average stay in the hospital is one night."
TAVR has rapidly become the standard of care for patients with aortic stenosis, with the new tissue valves lasting 10 to 15 years. Longer-lasting metal, or mechanical valves, are used for traditional aortic valve replacement during open-heart surgery and may be best for younger patients.
Paying Attention and Follow Up
Follow-up physical exams and echocardiograms are recommended for patients with aortic stenosis every six to 12 months. That's because stenosis tends to get worse over time. "Someone with mild aortic stenosis in their 50s has a very high chance of it being moderate to severe by the time they're 80," Glotzbach says.
Stenosis can be insidious, and once you have symptoms it can get rapidly worse. "Some of our patients are stoic and in denial of symptoms and think, 'Oh, I'm just getting older,'," Glotzbach says. "But don't ignore functional decline. If your stamina and energy levels are going down and you cannot do things without getting winded, get checked out. TAVR may be able to help you."