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(TAVR; Transcatheter Aortic Valve Implantation; TAVI)

Definition

A transcatheter aortic valve replacement (TAVR) replaces a damaged heart valve with a new valve. These valves help to manage the flow of blood through the heart.

Reasons for Procedure

This surgery is done to treat aortic valve stenosis. It will repair the valve to improve blood flow out of the heart. TAVR can ease the symptoms and improve overall health.

Open heart surgery has been the only choice for valve replacement. TAVR may be a new option for some. It will cause less pain and have shorter recovery time than open surgery.

Possible Complications

Problems are rare, but all procedures have some risk. Your doctor will go over problems, like:

  • Adverse reaction to anesthesia
  • Infection
  • Blood clots
  • Bleeding
  • Kidney damage
  • The valve does not work as it should
  • Heart rhythm problems
  • Kidney disease
  • Heart attack
  • Stroke

Things that may raise the risk of problems are:

  • Smoking
  • Chronic diseases such as diabetes

What to Expect

Prior to Procedure

Test results will be reviewed. Lung function tests may also be done.

You will need to:

  • Arrange for a ride home.
  • Talk to your doctor about the medicines and supplements that you take. Some may need to be stopped up to 1 week before surgery.
  • Avoid food or drink after midnight the night before surgery.

Anesthesia

General anesthesia may be used. It will block pain and keep you asleep.

Description of the Procedure

IV medicines will be given. They will help to lower the chance of infection and blood clots. A pacemaker may be placed. A small wire will be threaded through blood vessels and into the heart. It will make sure the heart is beating at a steady rhythm.

A small incision will be made in the leg or chest. A hollow tube will be inserted in the incision. The new valve sits inside the tube. A machine in the room will take images of blood vessels to show where the tube is in the body. The tube will be passed through blood vessels until it reaches the damaged valve. The new valve will push damage valve flaps out of the way and sit over the old valve. The damaged valve does not need to be taken out. Images will be taken to make sure the new valve is working as it should. Then the tube will be removed. The incision will be closed and covered with bandages. The pacemaker may be removed or may be left in place.

How Long Will It Take?

90 minutes

Will It Hurt?

Anesthesia will prevent pain during surgery. The incision site will be sore. Pain medicine will ease discomfort.

Average Hospital Stay

Most people stay 2 to 5 days. Some may need to stay longer.

Post-procedure Care

At the Care Center

The care team will monitor vital signs. Medicines may be given to prevent blood clots. Walking will help blood flow and reduce risk of clots.

Staff will take steps to lower your chance of infection such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping incisions covered

You can take these steps to lower your chances of infection:

  • Washing your hands often and reminding others to do so
  • Reminding staff to wear gloves or masks
  • Not letting others touch your incisions
At Home

It will take many weeks to fully heal. Problems caused by aortic stenosis should be improved. Heavy lifting and straining will be limited for up to a week.

Call Your Doctor

Call your doctor if you are not getting better or you have:

  • Signs of infection, such as fever and chills
  • Nausea and vomiting
  • Heavy bleeding
  • Redness, swelling, or any discharge from the incision
  • Pain that does not go away with medicine

Call emergency medical services right away for:

Signs of a stroke:

  • Face drooping
  • Arm weakness
  • Speech problems

Signs of a heart attack:

  • Squeezing or tightness in the chest, shoulders, or back
  • Pain in the arms, back, neck, or jaw
  • Breathing problems

If you think you have an emergency, call for medical help right away.

RESOURCES

American Heart Association  https://www.heart.org 

Family Doctor—American Academy of Family Physicians  https://www.familydoctor.org 

CANADIAN RESOURCES

Health Canada  http://www.canada.ca 

Heart and Stroke Foundation of Canada  https://www.heartandstroke.ca 

References

Aortic stenosis. EBSCO DynaMed website. Available at:  https://www.dynamed.com/condition/aortic-stenosis . Updated December 13, 2019. Accessed February 14, 2020.

Grimard BH, Safford RE, et al. Aortic Stenosis: Diagnosis and Treatment. Am Fam Physician. 2016 Mar 1;93(5):371-378.

Transcatheter aortic valve replacement (TAVR). Stanford Health Care website. Available at: https://www.sanfordhealth.org/-/media/org/files/patient-education/019051-00247-booklet-patient-education-tavr-level-2-8%5F5x11.pdf. Published July 2017. Accessed February 14, 2020.

Transcatheter aortic valve implantation (TAVI)/replacement (TAVR). EBSCO DynaMed website. Available at:  https://www.dynamed.com/procedure/transcatheter-aortic-valve-implantation-tavi-replacement-tavr-29 . Updated December 3, 2019. Accessed February 14, 2020.

What is TAVR? American Heart Association website. Available at: https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/understanding-your-heart-valve-treatment-options/what-is-tavr. Updated August 29, 2019. Accessed February 14, 2020.

What is TAVR? Stanford Health Care website. Available at: https://stanfordhealthcare.org/medical-treatments/t/transcatheter-aortic-valve-replacement-tavr.html. Accessed February 14, 2020.

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