TAVR (transcatheter aortic valve replacement), also called TAVI (transcatheter aortic valve implantation), is a minimally invasive surgical procedure used to repair a heart valve without removing the old, damaged valve. Instead, it wedges a replacement valve into the aortic valve’s place. TAVR/TAVI can be an effective option to improve quality of life in patients who otherwise have limited choices for repair of their aortic valve.

How It Works:

This procedure is fairly new and is FDA approved for people with symptomatic aortic stenosis who are considered an intermediate or high risk patient for standard valve replacement surgery. The differences in the two procedures are significant.

Usually valve replacement requires an open heart procedure with a sternotomy, in which the chest is surgically opened and separated. The TAVR or TAVI procedures can be done through very small openings that leave all the chest bones in place.

Somewhat similar to a stent placed in an artery, the TAVR approach delivers a fully collapsible replacement valve to the valve site through a catheter. Once the new valve is expanded, it pushes the old valve leaflets out of the way and the tissue in the replacement valve takes over the job of regulating blood flow.

The TAVR procedure is performed using one of two different approaches, allowing the cardiologist or surgeon to choose which one provides the best and safest way to access the valve.

Transfemoral Approach – entering through the femoral artery (large artery in the groin), which does not require a surgical incision in the chest.

Transapical approach – a minimally invasive surgical approach with a small incision in the chest and entering through a large artery in the chest or through the tip of the left ventricle (the apex).

Risks:

A TAVR procedure is not without risks, but it provides beneficial treatment options to people who may not have been candidates for them a few years ago while also providing the added bonus of a faster recovery in most cases. A patient’s experience with a TAVR procedure may be comparable to a balloon treatment or even an angiogram in terms of downtime and recovery, and will likely require a shorter hospital stay (average 3-5 days).

Who is a good candidate for this type of valve surgery?
At this time the procedure is reserved for those patients whom an open heart procedure poses intermediate risk. For that reason, most people who have this procedure are in their 70s or 80s and often have other medical conditions that make them a better candidate for this type of surgery.