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Transcatheter aortic valve replacement

Valvuloplasty - aortic; TAVR; Transcatheter aortic valve implantation (TAVI)

Transcatheter aortic valve replacement (TAVR) is a procedure used to replace the aortic valve without opening the chest. It is used to treat adults who aren't healthy enough for regular valve surgery.

The aorta is a large artery that carries blood from your heart to the rest of your body. Blood flows out of your heart and into the aorta through a valve. This valve is called the aortic valve. It opens up so blood can flow out. It then closes, keeping blood from flowing backwards.

An aortic valve that does not open fully will restrict blood flow. This is called aortic stenosis. If there is also a leak, it is called aortic regurgitation. Most aortic valves are replaced because they restrict flow forward through the aorta to the brain and body.

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Description

The procedure will be done in a hospital. It will take about 2 to 4 hours.

Why the Procedure Is Performed

TAVR is used for people with severe aortic stenosis who aren't healthy enough to have open chest surgery to replace a valve.

In adults, aortic stenosis is most often due to calcium deposits that narrow the valve. This generally affects older people.

TAVR may be done for these reasons:

This procedure has many benefits. There is less pain, blood loss, and risk of infection. You will also recover faster than you would from open-chest surgery.

Risks

Risks of any anesthesia are:

Other risks are:

Before the Procedure

Always tell your doctor or nurse what medicines you are taking, including over-the counter medicines, supplements, or herbs.

You should see your dentist to make sure there are no infections in your mouth. If untreated, these infections may spread to your heart or new heart valve.

For the 2-week period before surgery, you may be asked to stop taking medicines that make it harder for your blood to clot. These might cause increased bleeding during the surgery.

During the days before your procedure:

On the day of your surgery:

After the Procedure

You can expect to spend 1 to 4 days in the hospital.

You will spend the first night in an intensive care unit (ICU). Nurses will monitor you closely. Usually within 24 hours, you will be moved to a regular room or a transitional care unit in the hospital.

The day after surgery, you will be helped out of bed so you can get up and move around. You may begin a program to make your heart and body stronger.

Your health care providers will show you how to care for yourself at home. You will learn how to bathe yourself and care for the surgical wound. You will also be given instructions for diet and exercise. Be sure to take any medicines as prescribed. You may need to take blood thinners for the rest of your life.

Your doctor will have you come in for a follow-up appointment to check that the new valve is working well.

Be sure to tell any of your providers that you have had a valve replacement. Be sure to do this before having any medical or dental procedures.

Outlook (Prognosis)

Having this procedure can improve the quality of your life and help you live longer than you might without the procedure. You may breathe easier and have more energy. You may be able to do things you couldn't do before because your heart is able to pump oxygen-rich blood to the rest of your body.

It's unclear how long the new valve will keep working, so be sure to see your doctor for regular appointments.

References

Arsalan M, Kim W-K, Walther T. Transcatheter aortic valve replacement. In: Sellke FW, Ruel M, eds. Atlas of Cardiac Surgical Techniques. 2nd ed. Philadelphia, PA: Elsevier; 2019:chap 16.

Herrmann HC, Mack MJ. Transcatheter therapies for valvular heart disease. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 72.

Lindman BR, Bonow RO, Otto CM. Aortic valve disease. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 68.

Patel A, Kodali S. Transcatheter aortic valve replacement: indications, procedure, and outcomes. In: Otto CM, Bonow RO, eds. Valvular Heart Disease: A Companion to Braunwald's Heart Disease. 5th ed. Philadelphia, PA: Elsevier; 2021:chap 12.

Thourani VH, Iturra S, Sarin EL. Transcatheter aortic valve replacement. In: Sellke FW, del Nido PJ, Swanson SJ, eds. Sabiston and Spencer Surgery of the Chest. 9th ed. Philadelphia, PA: Elsevier; 2016:chap 79.

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Review Date: 6/25/2020  

Reviewed By: Micaela Iantorno, MD MSc FAHA RPVI, Interventional Cardiologist at Mary Washington Hospital Center, Fredericksburg, VA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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