Table of ContentsView AllTable of ContentsWhat It IsPurposeHow to PrepareWhat to ExpectRecovery
Table of ContentsView All
View All
Table of Contents
What It Is
Purpose
How to Prepare
What to Expect
Recovery
Transcatheter aortic valve replacement (TAVR)—also referred to as transcatheter aortic valve implantation—is a minimally invasive heart surgery in which a malfunctioningaortic valveis replaced with an artificial one. This procedure is a less invasive alternative to the traditionalopen-heart surgerymethod of replacing a heart valve.
Because of this, TAVR is often favored for patients at high risk of surgical complications, although it is still a major surgery that can have complications. TAVR is also being considered more and more for people who don’t have such pre-operative concerns.
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What Is TAVR?
A transcatheter procedure is a type of surgery that relies on a small incision in the skin to thread a catheter (small tube) through a blood vessel to reach the surgical destination. An aortic valve replacement involves the implantation of an expandableartificial valvemade of metal and animal tissue into the heart.
If you have a TAVR, your artificial aortic valve would be inserted into its position after your surgeon advances it through a catheter to theaorta.
The aorta, which emerges directly from the heart, is the largest artery you have. Its branches carry oxygenated blood from the heart to the rest of your body. The aortic valve—composed of several cusps of tissue—is located between the heart and the aorta, and it helps control blood flow between the two.
An interventional cardiologist or a heart surgeon would perform your TAVR. Your incision will either be in your groin (undermonitored anesthesia sedationand local anesthesia) or in your chest (undergeneral anesthesia).
The Heart’s Chambers and Valves
Contraindications
You might not be a candidate for TAVR if your health is very unstable or if you have mild aortic valve disease.
You can have a high risk of surgical complications or death from this procedure if you have organ failure (such as kidney failure or pulmonary failure). This could make TAVR more risky than beneficial for you.
Additionally, if you have a life expectancy of less than a year (e.g., you have end-stage cancer), this surgery could increase your risk of death.
Your health insurance payer might not approve this minimally invasive method ofvalve replacementif you have mild aortic disease or a low risk of surgical complications. The guidelines regarding the indications for selecting this procedure instead of an open aortic valve replacement are changing.
Potential Risks
Therisks of general anesthesiaand any surgical procedure apply to TAVR. This surgery also poses a risk of some additional concerns.
Possible complications of TAVR replacement include:
Complications after heart surgery can be serious and may be life-threatening. You will be closely monitored in the hospital for the first day after your operation so your healthcare providers can identify signs of problems at an early stage.
Risks and Complications of Open Heart Surgery
Purpose of TAVR
A TAVR is done to replace—not repair—a damaged aortic heart valve.
When the aortic valve is damaged due to calcification, its cusps do not move the way they should. This can causeaortic regurgitation(when blood leaks back from the aorta into the heart) and/oraortic stenosis(when the aortic valve does not fully open, making it more difficult for the heart to expel blood into the aorta).
Aortic valve disease is common and typically develops with age. It can cause fatigue, exercise intolerance, syncope (episodes of fainting), chest pain, andcongestive heart failure. The condition can become so severe that it will be life-threatening if left untreated.
Replacement of the aortic valve can alleviate symptoms of aortic valve disease and may prolong life.
Before having a TAVR, you will have an assessment of your aortic valve. Your surgeon will likely observe the function of your heart and the structure and motion of your aortic valve with anechocardiogram. Measurements of the valve and the aorta will be taken in preparation for your surgery.
Additionally, you will have an ultrasound test to assess the size and patency (extent of opening) of blood vessels that will be accessed during your surgery.
Your pre-operative testing will include acomplete blood count (CBC),blood chemistry tests, a chest X-ray, and anelectrocardiogram (EKG).
Location
You will go to your surgery from home, and you will spend at least one night in the hospital after your operation. Your procedure will be done in a hospital operating room or procedural suite.
What to Wear
You can wear anything comfortable to your surgery appointment. You will have to wear a hospital gown during a TAVR.
Food and Drink
If you are having general anesthesia, you need to fast from food and drink after midnight the night before your surgery.
If you are having monitored anesthesia sedation, you may also need to adjust your food and drink in preparation for your surgery—check with your surgeon’s office regarding their specific instructions.
Medications
Your healthcare provider will instruct you about whether you should adjust the dose of any blood thinners or medications that you take for treating heart disease.
Be sure your healthcare provider is aware of any and all medications and supplements you take, whether prescription, over-the-counter, herbal, or recreational.
What to Bring
When you go to your surgery appointment, bring your identification and insurance information. If you will be paying for a portion of your surgery, you should bring a form of payment.
Pack whatever you need for your hospital stay, such as a change of clothes, toiletries, and so on. Leave any valuables at home.
You should have someone who can drive you home when you are discharged from the hospital.
Pre-Op Lifestyle Changes
Smoking can interfere with recovery, so your healthcare provider may talk to you about smoking cessation prior to your surgery.
What to Expect on the Day of Surgery
When you go for your surgery, you will have to register and sign a consent form. A staff member will then escort you to a pre-operative area, where you will change into a hospital gown.
You may have same-day tests, including a CBC as well as blood chemistry andurinalysis. You may have aurinary catheterplaced before you go to the operating room or after you get there.
An intravenous (IV, or in a vein) line placed in your hand or arm. You will have your temperature, blood pressure, pulse, respiratory rate, and oxygen saturation level checked.
Before the Surgery
Once in the operating room, your body will be covered with a surgical drape, and the area of skin where you will have your incision will be exposed and cleansed. Your anesthesia will be started as an injection into your IV.
For general anesthesia, the medication will put you to sleep, and you will have a breathing tube placed in your throat for breathing assistance during surgery. For monitored anesthesia sedation, you will have anesthetic medication injected in your IV to make you drowsy, and local anesthesia will be placed in the skin near the incision site.
During the Surgery
The catheter is placed into the artery through the skin incision. With imaging guidance, the catheter and the replacement valve are advanced through the blood vessels until they reach the aortic valve.
The artificial valve is bundled into a tiny package that is small enough to be moved through the blood vessel along with the catheter. When in place, the valve replacement is deployed, allowing it to open to its full size.
Usually, the replacement valve is placed over the original diseased aortic valve so it can take over the function of controlling the release of blood from the heart.
The diseased valve is not typically removed, although atherosclerotic plaque may be resected from the valve tissue. If you’ve had an artificial valve placed in the past, the new TAVR valve will be placed inside the preexisting valve.
After the replacement valve is properly positioned, your surgeon will observe its function using imaging studies. If the placement is correct and the valve is functioning properly, the catheter will be removed. If any adjustment is needed, that will be done before the catheter is removed.
The blood vessel and skin incision will each be closed with sutures, and your skin will be covered with a surgical dressing.
When the procedure is complete, anesthesia will be stopped or reversed. If you have had a breathing tube during your surgery, it will be removed, and your anesthesia team will ensure that you are breathing comfortably on your own.
After the Surgery
In the recovery area, you will begin to wake up. You may feel a little groggy. The medical team in the recovery area will help you walk and give you medication for pain as needed.
During your hospital stay, your heart function will be monitored with an EKG, and your oxygen saturation will be monitored withpulse oximetry.Your blood pressure, pulse, and respiratory rate will be monitored as well.
Your surgical wound will be checked, and your medical team will explain how you should care for it at home.
During your recovery, you may have some of your heart medications, like your blood pressure medication, adjusted. You will get blood thinner medication while you’re in the hospital, as well as a prescription for blood thinner medication to take home to prevent blood clots. You may also get a prescription for pain medication to take at home.
After one day or a few days, you will be discharged.
You should feel comfortable as you are recovering after your valve replacement. You may begin to feel more energetic than you did prior to your surgery within days of your procedure.
However, you should take it easy as your wound heals and until your healthcare provider evaluates your heart function. Avoid driving and physically demanding activities like heavy lifting, pushing, or pulling. While your valve repair will certainly alleviate some of your heart function issues, you might still have limitations due to another remaining heart concern.
During follow-up appointments with your healthcare provider, your wound will be examined, sutures removed, and your heart function evaluated.
The small incision TAVR employs should heal within about a week. If you have developed heart disease (e.g., heart failure) prior to having your valve replacement, your healthcare provider may recommend that you begin cardiac rehabilitation.
The 4 Phases of Cardiac Rehab
Healing
In your first few days home after your surgery, you might have mild to moderate pain at your incision site. You can take pain medication as directed. You will need to get up and walk around to avoid complications like blood clots. Your healthcare provider may even prescribe a target number of steps for you to take.
If you have mild swelling, you can use an ice pack to reduce the swelling. Don’t place the ice pack directly on your skin.
Signs of complications to look out for include:
Call your healthcare provider
’s office if you start to experience any of these issues.
Coping With Recovery
As you are recovering, you may need to adjust to taking new medications. Blood thinners can make you prone to bleeding, so you have to be careful about avoiding injury.
You may also be taking new medications or different doses of your previous medications for the treatment of heart failure or hypertension. Be sure to stay in touch with your healthcare provider if you experience any side effects of these treatments, such as lightheadedness, shortness of breath, fatigue, or palpitations.
Some people have a decreased appetite after TAVR, especially if low appetite was a problem prior to the surgery. Research suggests that nutritional deficits can interfere with a healthy recovery.Talk to your healthcare provider about your dietary intake so you can receive treatment with dietary supplements if you need them.
Blood Thinners After Heart Valve Surgery
Long-Term Care
After TAVR, you will still need to take steps for a healthier heart if you have other issues, such asatherosclerosis,hypertension,heart failure, or arrhythmia. Having a heart valve replacement can have a major positive impact on your health, but it doesn’t addressallheart problems. Heart disease is usually managed with a combination of medication and lifestyle adjustments.
You will also need periodic monitoring of your heart function, which can include an EKG and an echocardiogram.
Reducing Risk of Endocarditis
Possible Future Surgeries
Although a valve can last for your whole lifetime, this is not always the case. Depending on the valve that you have, you may need a replacement after 10 or 15 years.
If your valve begins to lose optimal function, you may develop symptoms of aortic valve disease. You and your healthcare provider will have to discuss whether another surgery is advisable if your valve starts to fail.
Many times, the same risk factors that led to aortic valve disease can lead to other heart problems, such ascoronary artery diseaseor cardiac arrythmia. This may require you to have another type of heart surgery after your TAVR.
Lifestyle Adjustments
Overall, you should feel better after your TAVR than you did before the surgery. The most important adjustment you have to consider is the risk of bleeding due to blood thinners. You may have already been taking blood thinners for years prior to your TAVR surgery, so this may not necessarily be a change for you.
The risk of bleeding means that you need to avoid activities that could cause major falls, such as hiking or climbing on an irregular surface. You may even need to be extra careful when biking or walking up and down the stairs, especially if you don’t have good balance.
Staying active, maintaining a low cholesterol diet, and avoiding smoking are vital steps to preventing future heart issues like aortic valve disease.
A Word From Verywell
Having a minimally invasive aortic valve replacement can improve symptoms of aortic valve disease and can prevent death due to this disease. The surgery would give you a faster recovery time than open-heart valve replacement. But because a TAVR is a type of heart surgery, advance surgical planning is a major part of the process, and there is a risk of surgical and post-surgical complications that you need to consider when thinking about having this operation.
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Cubero-Gallego H, Dam C, Meca J, Avanzas P.Transcatheter aortic valve replacement (TAVR): expanding indications to low-risk patients.Ann Transl Med.2020 Aug;8(15):960. doi: 10.21037/atm.2020.03.155. PMID: 32953760; PMCID: PMC7475389.Poulis N, Zaytseva P, Gähwiler EKN, Motta SE, Fioretta ES, Cesarovic N, Falk V, Hoerstrup SP, Emmert MY.Tissue engineered heart valves for transcatheter aortic valve implantation: current state, challenges, and future developments.Expert Rev Cardiovasc Ther.2020 Sep 23:1-16. doi: 10.1080/14779072.2020.1792777. Epub ahead of print. PMID: 32791869.American College of Cardiology.ACC expert consensus on TAVR for adults with aortic stenosis. January 24, 2017.Prendergast BD, Redwood SR.Transcatheter aortic valve replacement.Circulation. 2019 Jun 11;139(24):2724-2727. doi: 10.1161/CIRCULATIONAHA.119.040016. Epub 2019 Jun 10. PMID: 31180746Winter MP, Bartko P, Hofer F, Zbiral M, Burger A, Ghanim B, Kastner J, Lang IM, Mascherbauer J, Hengstenberg C, Goliasch G.Evolution of outcome and complications in TAVR: a meta-analysis of observational and randomized studies.Sci Rep.2020 Sep 23;10(1):15568. doi: 10.1038/s41598-020-72453-1. PMID: 32968104.American Heart Association.Transcatheter aortic valve replacement (TAVR).Moriyama N, Lehtola H, Miyashita H, Piuhola J, Niemelä M, Laine M.Hemodynamic comparison of transcatheter aortic valve replacement with the SAPIEN 3 Ultra versus SAPIEN 3: The HomoSAPIEN registry.Catheter Cardiovasc Interv.2020 Sep 23. doi: 10.1002/ccd.29281Itoh H, Kaneko H.Appetite status after transcatheter aortic valve implantation.Int Heart J.2019;60(6):1236-1237. doi: 10.1536/ihj.19-550. PMID: 31787632.American Heart Association.Infective (bacterial) endocarditis wallet card. March 6, 2020.
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Cubero-Gallego H, Dam C, Meca J, Avanzas P.Transcatheter aortic valve replacement (TAVR): expanding indications to low-risk patients.Ann Transl Med.2020 Aug;8(15):960. doi: 10.21037/atm.2020.03.155. PMID: 32953760; PMCID: PMC7475389.Poulis N, Zaytseva P, Gähwiler EKN, Motta SE, Fioretta ES, Cesarovic N, Falk V, Hoerstrup SP, Emmert MY.Tissue engineered heart valves for transcatheter aortic valve implantation: current state, challenges, and future developments.Expert Rev Cardiovasc Ther.2020 Sep 23:1-16. doi: 10.1080/14779072.2020.1792777. Epub ahead of print. PMID: 32791869.American College of Cardiology.ACC expert consensus on TAVR for adults with aortic stenosis. January 24, 2017.Prendergast BD, Redwood SR.Transcatheter aortic valve replacement.Circulation. 2019 Jun 11;139(24):2724-2727. doi: 10.1161/CIRCULATIONAHA.119.040016. Epub 2019 Jun 10. PMID: 31180746Winter MP, Bartko P, Hofer F, Zbiral M, Burger A, Ghanim B, Kastner J, Lang IM, Mascherbauer J, Hengstenberg C, Goliasch G.Evolution of outcome and complications in TAVR: a meta-analysis of observational and randomized studies.Sci Rep.2020 Sep 23;10(1):15568. doi: 10.1038/s41598-020-72453-1. PMID: 32968104.American Heart Association.Transcatheter aortic valve replacement (TAVR).Moriyama N, Lehtola H, Miyashita H, Piuhola J, Niemelä M, Laine M.Hemodynamic comparison of transcatheter aortic valve replacement with the SAPIEN 3 Ultra versus SAPIEN 3: The HomoSAPIEN registry.Catheter Cardiovasc Interv.2020 Sep 23. doi: 10.1002/ccd.29281Itoh H, Kaneko H.Appetite status after transcatheter aortic valve implantation.Int Heart J.2019;60(6):1236-1237. doi: 10.1536/ihj.19-550. PMID: 31787632.American Heart Association.Infective (bacterial) endocarditis wallet card. March 6, 2020.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Cubero-Gallego H, Dam C, Meca J, Avanzas P.Transcatheter aortic valve replacement (TAVR): expanding indications to low-risk patients.Ann Transl Med.2020 Aug;8(15):960. doi: 10.21037/atm.2020.03.155. PMID: 32953760; PMCID: PMC7475389.Poulis N, Zaytseva P, Gähwiler EKN, Motta SE, Fioretta ES, Cesarovic N, Falk V, Hoerstrup SP, Emmert MY.Tissue engineered heart valves for transcatheter aortic valve implantation: current state, challenges, and future developments.Expert Rev Cardiovasc Ther.2020 Sep 23:1-16. doi: 10.1080/14779072.2020.1792777. Epub ahead of print. PMID: 32791869.American College of Cardiology.ACC expert consensus on TAVR for adults with aortic stenosis. January 24, 2017.Prendergast BD, Redwood SR.Transcatheter aortic valve replacement.Circulation. 2019 Jun 11;139(24):2724-2727. doi: 10.1161/CIRCULATIONAHA.119.040016. Epub 2019 Jun 10. PMID: 31180746Winter MP, Bartko P, Hofer F, Zbiral M, Burger A, Ghanim B, Kastner J, Lang IM, Mascherbauer J, Hengstenberg C, Goliasch G.Evolution of outcome and complications in TAVR: a meta-analysis of observational and randomized studies.Sci Rep.2020 Sep 23;10(1):15568. doi: 10.1038/s41598-020-72453-1. PMID: 32968104.American Heart Association.Transcatheter aortic valve replacement (TAVR).Moriyama N, Lehtola H, Miyashita H, Piuhola J, Niemelä M, Laine M.Hemodynamic comparison of transcatheter aortic valve replacement with the SAPIEN 3 Ultra versus SAPIEN 3: The HomoSAPIEN registry.Catheter Cardiovasc Interv.2020 Sep 23. doi: 10.1002/ccd.29281Itoh H, Kaneko H.Appetite status after transcatheter aortic valve implantation.Int Heart J.2019;60(6):1236-1237. doi: 10.1536/ihj.19-550. PMID: 31787632.American Heart Association.Infective (bacterial) endocarditis wallet card. March 6, 2020.
Cubero-Gallego H, Dam C, Meca J, Avanzas P.Transcatheter aortic valve replacement (TAVR): expanding indications to low-risk patients.Ann Transl Med.2020 Aug;8(15):960. doi: 10.21037/atm.2020.03.155. PMID: 32953760; PMCID: PMC7475389.
Poulis N, Zaytseva P, Gähwiler EKN, Motta SE, Fioretta ES, Cesarovic N, Falk V, Hoerstrup SP, Emmert MY.Tissue engineered heart valves for transcatheter aortic valve implantation: current state, challenges, and future developments.Expert Rev Cardiovasc Ther.2020 Sep 23:1-16. doi: 10.1080/14779072.2020.1792777. Epub ahead of print. PMID: 32791869.
American College of Cardiology.ACC expert consensus on TAVR for adults with aortic stenosis. January 24, 2017.
Prendergast BD, Redwood SR.Transcatheter aortic valve replacement.Circulation. 2019 Jun 11;139(24):2724-2727. doi: 10.1161/CIRCULATIONAHA.119.040016. Epub 2019 Jun 10. PMID: 31180746
Winter MP, Bartko P, Hofer F, Zbiral M, Burger A, Ghanim B, Kastner J, Lang IM, Mascherbauer J, Hengstenberg C, Goliasch G.Evolution of outcome and complications in TAVR: a meta-analysis of observational and randomized studies.Sci Rep.2020 Sep 23;10(1):15568. doi: 10.1038/s41598-020-72453-1. PMID: 32968104.
American Heart Association.Transcatheter aortic valve replacement (TAVR).
Moriyama N, Lehtola H, Miyashita H, Piuhola J, Niemelä M, Laine M.Hemodynamic comparison of transcatheter aortic valve replacement with the SAPIEN 3 Ultra versus SAPIEN 3: The HomoSAPIEN registry.Catheter Cardiovasc Interv.2020 Sep 23. doi: 10.1002/ccd.29281
Itoh H, Kaneko H.Appetite status after transcatheter aortic valve implantation.Int Heart J.2019;60(6):1236-1237. doi: 10.1536/ihj.19-550. PMID: 31787632.
American Heart Association.Infective (bacterial) endocarditis wallet card. March 6, 2020.
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