Transcatheter Aortic Valve Replacement

Overview

Transcatheter aortic valve replacement (TAVR), sometimes called Transcatheter Aortic Valve Implantation (TAVI), is a minimally invasive procedure used to replace the aortic valve in patients with aortic valve stenosis. The aortic valve is a “one-way check valve” that allows blood to go from the left side of the heart to the brain and the rest of the body. As we age, calcium may build up on the valve, causing it to narrow and not open. Aortic valve stenosis refers to narrowing that valve so that it doesn’t fully open and less blood flows to the rest of the body.

Symptoms of aortic valve stenosis occur as the heart works hard to squeeze blood through the restricted valve to the rest of the body. The most common symptoms of aortic valve stenosis include the following:

• Shortness of breath on exertion (exertional dyspnea)
• Angina (chest pain)
• Syncope (fainting)
• A gradual decrease in the ability to exercise
• Feeling fatigued
• Heart palpitations

Often, the diagnosis is made after the doctor hears a heart murmur with a stethoscope and orders an echocardiogram (echo) to investigate further.

Sometimes, aortic valve stenosis can be present, but the patient has no symptoms. In these cases, patients should follow up with a cardiologist closely for symptoms and findings of aortic valve disease progression.

Once symptoms appear, the disorder tends to advance quickly and it’s important to treat it. If left untreated, aortic valve stenosis can lead to more serious disorders, including heart failure and eventually leading to death.

After the onset of symptoms, a timer starts: After two years, 50% of patients are no longer alive, and at five years, it increases to about 80%.¹ 

TAVR vs. SAVR

Surgical aortic valve replacement (SAVR) was previously considered the only treatment for most patients with symptomatic aortic valve stenosis, as long as they weren’t too sick to undergo the procedure. Unlike SAVR, TAVR is a less-invasive option to conventional open-heart surgery. Instead of opening the chest, stopping the heart and being placed on a heart and lung machine, and cutting out the old valve and replacing it with a new one, TAVR uses a flexible tube called a catheter that reaches the heart through the artery in the groin (like the heart catheterization) to access the faulty valve and implant a new artificial valve inside the existing valve, which is pushed to the side once the new valve is deployed.

References

1. National Library of Medicine (NLM), National Institutes of Health (NIH)