When a patient is diagnosed with aortic valve stenosis and he or she is not a good candidate for surgery, transcatheter aortic valve replacement is a minimally invasive treatment option. Without opening up the person’s chest, the TAVR procedure relieves the side effects of the condition, which include tightness in the chest, fatigue, shortness of breath, chest pains, and heart palpitations.
What is a transcatheter aortic valve replacement?
Aortic valve stenosis is a type of heart disease in which blood isn’t able to flow freely from the heart to the rest of the body. This happens when the aortic valve is unable to open completely, restricting the space in which the blood has to circulate. TAVR surgery, or transcatheter aortic valve implantation (TAVI) as it’s sometimes known, uses a catheter to insert a balloon into the artery. The procedure expands the natural valve and leaves a replacement one to take over the function of carrying blood away from the heart.
Is TAVR the standard for valve replacement?
A traditional valve replacement requires open heart surgery with a sternotomy, and involves removing the malfunctioning piece of the valve and replacing it with a manufactured one. This may be a mechanical version or a replacement valve made from animal tissue. TAVR is a somewhat new procedure that was just approved by the FDA and uses a small incision to access the collapsing artery as opposed to surgically separating the patient’s chest.
What does the TAVR procedure involve?
A patient undergoing TAVR surgery will have a catheter inserted into and threaded through the aortic valve. At the end of the catheter, a small balloon device will inflate once inside the aortic artery, expanding the restricted walls. Attached to the balloon is a replacement valve, which is condensed upon entry into the artery. The inflating of the balloon pushes the natural, faulty valve out of the way, and drops the replacement in its place at the narrowed portion of the aortic valve.
As soon as the surgeon deflates the balloon and blood is allowed to pass through again, the replacement valve takes over the regulation of blood flow. The new valve is essentially an inflated, artificial version of the natural artery and provides immediate improved circulation.
The catheter is generally inserted into the aortic valve via one of two methods:
- Transfemoral: A small incision is cut into the patient’s thigh and the catheter is routed up to the heart through a large artery in the groin.
- Transapical: A small incision is cut in between the ribs on the chest and the catheter is inserted into a large artery or the tip of the apex.
Which approach is right for each individual is determined by the surgeon or cardiologist based on the patient’s other health issues and risks of complications.
What makes a patient a good candidate for transcatheter heart valve replacement surgery?
While every case of aortic valve stenosis is different and every patient needs to be assessed individually, overall health is the major factor in whether someone is a good candidate for TAVR. Transcatheter aortic valve replacement is generally suggested for those whose health makes open heart surgery too risky. If a patient is determined to be especially prone to complications from traditional valve replacement due to other medical conditions, they may also be deemed a good candidate for TAVR or TAVI. Because of these conditions, most of the patients who undergo this procedure are over the age of 70.
TAVR/TAVI can be an effective procedure for treating valve stenosis heart disease in many who formerly did not have a solution. With a less invasive approach and shorter recovery time, transcatheter aortic valve replacement is improving quality of life for patients whose disease has limited them.