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Transcatheter Aortic Valve Replacement / Implantation (TAVR / TAVI)

Overview

Transcatheter aortic valve replacement (TAVR), also known as transcatheter aortic valve implantation (TAVI), is a non-surgical minimally invasive procedure to treat aortic valve stenosis, a condition in which the valve between the main artery (aorta) and the heart narrows due to thickening of the valve walls.

TAVR can provide relief for the signs and symptoms of aortic valve stenosis. It may increase survival rates for people believed to be at intermediate or high risk of surgical complications from aortic valve replacement or for those who cannot undergo open-heart surgery.

TAVR is done to replace the aortic valve in people with aortic valve stenosis.

  • Aortic valve stenosis — or aortic stenosis — occurs when the heart’s aortic valve narrows.
  • This narrowing prevents the valve from opening fully, which obstructs blood flow from your heart into your aorta and from there to the rest of your body.

  • Aortic stenosis can cause chest pain, fainting, fatigue, leg swelling and shortness of breath.
  • It may also lead to heart failure and sudden cardiac death.

TAVR may be an option if you have aortic stenosis that causes signs and symptoms.

  • People who are considered at intermediate or high risk of developing complications after aortic valve replacement surgery.
    • This includes people with lung disease or kidney disease
  • People who have an existing biological tissue replacement valve that is not functioning well anymore.

Transcatheter aortic valve replacement (TAVR) carries a risk of complications, which may include:

  • Bleeding
  • Problems with the replacement valve, such as the valve slipping out of place or leaking
  • Stroke
  • Heart rhythm abnormalities (arrhythmias)
  • Kidney disease
  • Infection
  • Death

TAVR involves replacing your damaged aortic valve or your poorly functioning existing replacement valve with one made from cow or pig heart tissue, also called a biological tissue valve.

The decision to perform TAVR is made by a multidisciplinary group of medical and surgical heart specialists. Together, they determine an individual’s best treatment options.

  • Before TAVR, you will need to undergo tests and be evaluated by a multidisciplinary team of heart valve specialists to determine if you are suitable to undergo the treatment.
  • You will undergo an evaluation to ensure there are no risk factors that may impact you during the procedure.
  • You may also be prescribed medications to decrease infection risk prior to the procedure.

  • Before the TAVR procedure, you may be administered general anaesthesia.
  • Medication will be given to you intravenously so as to avoid the formation of blood clots.
  • Your heart function and rhythm will be monitored by the TAVR team. They will also keep an eye out for any changes in heart function. These changes can be treated as required during the procedure.
  • For the TAVR procedure, the access to your heart may be provided through a blood vessel in your leg. Access can also be provided through an incision in the chest, which permits the doctors to reach the heart via a large artery or the tip of the left ventricle (the bottom left chamber of the heart).
  • If these approaches are determined to be unsuitable, doctors may access the heart through other approaches.
  • A hollow tube or catheter is passed through the access point during TAVR.
  • Advanced imaging techniques are utilized by your doctor to move the catheter along your blood vessels, into the heart, and to the aortic valve.
  • Once the catheter is positioned precisely, your doctor will expand a balloon to press the replacement valve into place inside the native aortic valve. There are some valves that can be expanded without a balloon.
  • Once the valve is securely in place, the catheter is removed from your body.

  • You may be required to stay in the intensive care unit (ICU) for a night after your TAVR procedure.
  • Typically, you will stay in the hospital for two to five days after the procedure to recover.
  • Your doctor will prescribe blood-thinning medications to you after the procedure to prevent the formation of blood clots. They will also discuss with you how long you need to continue taking these medications.
  • You may need to continue taking certain medications after your procedure.
  • Your doctor will recommend that you take medications before certain dental procedures to prevent certain infections, as you are at higher risk of certain infections with a replacement heart valve. Talk to your doctor about his or her recommendations.
  • It is important that you take your medications as prescribed.
  • You will likely need regular follow-up appointments with your doctor.
  • Let your doctor know if you have any new or worsening signs or symptoms. Your doctor may recommend that you make healthy lifestyle changes, such as eating a heart-healthy diet, exercising regularly, maintaining a healthy weight and avoiding smoking.

  • TAVR can decrease the risk of death and improve the lives of people with aortic stenosis who cannot have surgery or for whom surgery is too risky by relieving the signs and symptoms of aortic valve stenosis and improve overall health.
  • 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.
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