When you have a heart condition, it’s important to know your options. If you or a loved one has been diagnosed with aortic valve disease and needs a valve replacement, one of those options may be a TAVR procedure – a newer treatment that’s helping patients feel better and live longer.
But what is a TAVR procedure? Is TAVR a major surgery? And how does it differ from open-heart surgery? Keep reading for answers to frequently asked questions about TAVR heart surgery.
What is TAVR?
TAVR – which stands for transcatheter aortic valve replacement – is a minimally invasive heart procedure to replace a diseased aortic valve. TAVR can also be done to replace an artificial aortic valve that isn’t working as well as it should.
During the procedure, your doctor puts a long, thin tube called a catheter through a blood vessel in your upper leg and moves it up into your heart. The doctor then uses a special tool to move the artificial valve through the catheter and position it over your aortic valve.
You may also have heard the term TAVI, which stands for transcatheter aortic valve implantation. TAVI is the same procedure – it’s just that doctors may use the term TAVI vs. TAVR.
Why would I need TAVR?
The most common reason for TAVR is aortic stenosis, which is the narrowing (stenosis) of the aortic valve opening or the surrounding area. If your aortic valve is stenosed, it doesn’t fully open or close – making it harder for the blood to move from the heart to the rest of the body. When this happens, people often experience symptoms such as fatigue, chest pain, shortness of breath or a rapid heartbeat.
Narrowing of the aortic valve can be caused by calcium that builds up on the aortic valve over time. But aortic stenosis can happen if someone has a bicuspid aortic valve, a type of heart disease that you’re born with. Aortic stenosis affects 20% of people over the age of 65 years old, according to the American Heart Association.
There are different stages of aortic stenosis. If you have mild symptoms, you won’t need surgery – at least not right away. Instead, your doctor may recommend lifestyle changes or medications to treat your symptoms and lower your chance of complications. But severe cases of aortic stenosis can damage the heart muscle and lead to heart failure and death. So the sooner you get treated for aortic stenosis, the better.
SAVR vs. TAVR: What’s the difference?
SAVR – or surgical aortic valve replacement – is the other way that doctors can place an artificial aortic valve into your heart. The big difference between these two procedures is that SAVR is open-heart surgery.
During SAVR, a surgeon will cut through your chest and breastbone to reach your heart. They’ll also need to use a cardiopulmonary bypass machine to temporarily stop your heart so they can access the aortic valve within the heart. TAVR is much less invasive and doesn’t require stopping the heart. But despite the differences, the two procedures are about equally safe.
The good news is that aortic valve replacement – either through a TAVR procedure or open-heart surgery – can restore heart function, helping you feel better and live longer.
Key differences between TAVR and SAVR
|Surgery time||1 hour||4 hours|
|Incision size and location||2 inches in your groin||6-8 inches down the middle of your chest|
|Durability of artificial valve||Unknown, but at least 5 years||At least 15 years|
When is TAVR recommended over SAVR?
TAVR is an option for most people who have severe aortic stenosis. But there are some situations when one approach may be better than the other.
TAVR may be recommended when:
- The patient is not healthy enough for open-heart surgery.
- The patient is over 80 years old with a life expectancy of less than 10 years.
- The patient currently has a biological tissue aortic valve that needs to be replaced.
SAVR may be better when:
- The valve replacement procedure is potentially more complex. For example, SAVR may be better when a person’s aortic valve has two flaps instead of three, there’s significant coronary disease or poor heart anatomy.
- The patient needs surgical correction of other conditions such as mitral valve problems or atrial fibrillation.
- The patient is younger than 65 years old with a life expectancy of more than 20 years.
Why isn’t TAVR the preferred option for younger patients?
Given all the benefits of TAVR you may wonder why it’s not the first recommendation for people of all ages. It has to do with how long the artificial valves last. The valves used in a SAVR procedure are proven to last at least 15 years, and in some people, they last even longer.
Because TAVR has only been around since 2012, it’s unknown how long those valves will last. There’s data showing that they’re usually good for at least for five years, but more research (and time) is needed to determine just how long they’ll last.
The bottom line is that if you’re young and get TAVR, you may need another TAVR procedure in the future. Or it may turn out that you’ll need to have SAVR later.
What happens during the TAVR procedure?
During the TAVR procedure, your doctor will perform the following steps:
- Make a small incision in the groin near the femoral artery, which is a blood vessel in your leg. (While not as common, it’s also possible that your doctor may start with an incision somewhere on your chest).
- Use the opening to slide a thin, flexible tube called a catheter into the blood vessel and then up into your heart.
- Put the replacement valve on the end of a special delivery instrument that’s designed to guide the catheter through the sheath. The valve has been compressed to fit through the tube and is attached to a balloon that will be used to expand the valve once it’s in place.
- Push the instrument with the replacement valve through the catheter to your aortic valve.
- Position the valve in the correct place and use the balloon to expand it. The artificial valve will push aside the flaps of your existing valve.
- Deflate the balloon and remove the catheter and delivery instrument from the blood vessel.
- Make sure the artificial aortic valve is working.
- Close the incision in your groin.
Are you awake for TAVR?
TAVR can be done with different types of sedation and medicines. For example, you may be fully asleep. Another approach is conscious sedation, which includes a mild sedative and pain killer. But no matter which types of sedation and medications you receive, you shouldn’t feel any pain during the procedure.
How long does TAVR take?
The actual procedure takes less than an hour. But you can expect to be in the procedure room for 2-3 hours.
Is TAVR a major surgery?
No, TAVR is a minimally invasive procedure. Still, it does carry similar risks to SAVR which is considered a major surgery.
What are possible TAVR complications?
All medical procedures and surgeries have some risks. Side effects and complications of TAVR include bleeding, damage to the femoral artery, leakage around the artificial valve, changes in your heart’s rhythm and kidney disease. Serious complications like stroke, heart attack, heart failure or death are extremely rare.
What to expect after TAVR
Your experience after TAVR will be different based on your heart health, age and overall health. But if you’ve ever had a coronary angiogram heart screening, you can expect recovery from TAVR to be similar. The following is some additional information about what to expect after your TAVR heart surgery:
How will I feel after TAVR?
You will likely have some pain at the incision site for a few days, but there are medications to help manage any discomfort.
How long does it take to recover from TAVR?
After a TAVR procedure, you may spend the night in the intensive care unit for monitoring, or you may go directly to a recovery room. The average hospital stay is three days, but some people leave the hospital the next day.
Recovery after TAVR is much quicker than with open-heart surgery. Most people who have TAVR have a better quality of life within 30 days of their procedure and feel even better at their 6-month follow-up appointment.
Are there any activity restrictions after TAVR?
Yes. You’ll need to take it easy for a little while. For a week after your procedure, you’ll need to:
- Skip strenuous sports.
- Avoid lifting anything that weighs more than 10 pounds.
- Hold off on driving and sexual intercourse until your doctor says it’s safe.
During your recovery process, your doctor will recommend certain heart healthy exercises to help you regain your strength and energy. But it may take weeks to months for you get back to your normal routine. Depending on your specific situation, your doctor may also recommend cardiac rehabilitation.
Will I need different medicines?
You’ll need to take a new medicine to prevent blood clots for about six months after your TAVR procedure. Your doctor will tell you if you should make changes to your current medications.
What should I eat after TAVR?
Your doctor may ask you to follow a special heart-healthy diet high in fruits, vegetables, whole grains, lean meats and healthy fats. Eating foods that are good for your heart can help your body and heart recover and stay strong after the procedure.
How will I know if I’m healing correctly?
The incision site will likely take about two weeks to heal. Your doctor will provide instructions about how to take care of the wound. If you notice redness, swelling, bleeding, infection or other signs of poor wound healing, you should contact your doctor.
You will also need to pay attention to how you’re feeling overall. If you have a fever, flu-like symptoms, or a fluttering heartbeat, call your doctor. Call 911 if you have shortness of the breath, chest pain, problems seeing or speaking, numbness, coolness or a change to the color of your legs.
How do I know if TAVR is right for me?
TAVR can help make people’s lives better and help them live longer – but it may not be the best option for everyone with aortic stenosis. Choosing to get TAVR is a decision that should be made after meeting with a cardiologist and other members of your heart health team to review your options.
To make sure you’re a good candidate for a TAVR, you’ll undergo a few different heart tests and screenings such as echocardiograms, computed tomography (CT) angiogram or a coronary angiogram. These tests will allow your doctors to check on the health of your heart – and the rest of your body. Based on the results of these tests, your care team will recommend the treatment option they feel is best for you.
Questions about aortic stenosis treatment options?
Choosing to have a medical procedure isn’t an easy decision. Get the answers you need from one of our top-ranked cardiologists. They can help you understand your heart health, discuss treatment options and refer you to a cardiac surgeon if needed.