By Carolyn Kasov, APRN

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Aortic stenosis one of the most common valve diseases afflicting our aging population. Defined as a narrowing due to extensive calcification in the heart's aortic valve, aortic stenosis can ultimately progress and cause symptoms that leave you with little energy to live your life. This narrowing prevents the valve from opening fully, which obstructs blood flow from your heart into your aorta and the rest of your body.

Aortic stenosis can cause chest pain, fainting, fatigue, lack of proper energy, leg swelling and shortness of breath. It may also lead to heart failure. Sometimes, in elderly people because of decrease of activity, the true symptoms might not be so obvious. Aortic valve stenosis is an extremely aggressive disease. If left untreated, it can progress quite rapidly and be life-threatening. You may be eligible for Transcatheter Aortic Valve Replacement, or TAVR.

Transcatheter Aortic Valve Replacement (TAVR) is a minimally invasive procedure in which the aortic valve is replaced without traditional open heart surgery. This less invasive procedure is currently commercially available in the US to patients who are considered intermediate or high risk for traditional surgery. Currently, most TAVRs are performed via a transfemoral approach with a catheter placed in the femoral artery (vessel in top of leg) to deliver the new prosthetic valve to the heart. TAVR is based on the same principle of other heart catheterization procedures (i.e. angioplasty/stent).

TAVR is performed on a beating heart and does not require cardio-pulmonary bypass. The TAVR valve is made of bovine (cow) pericardium (biological tissue valve) and is usually supported with a metal stent. The compressed tissue heart valve is placed on the delivery catheter and is positioned directly inside the diseased aortic valve. Once in position, the valve is securely delivered in place.

TAVR can improve the lives of people with aortic stenosis if surgery isn't an option due to underlying risks. In this case, TAVR can reduce the risk of death and may also relieve the signs and symptoms of aortic valve stenosis as well as improve overall health.

The following questions and answers will help to further guide you.

Before the tavr procedure

Surgery (SAVR) vs. TAVR: What's right for me?

We’ll do a full evaluation to determine the most appropriate treatment for you. Stamford Health’s Heart and Valve Center follows the Heart Team's principle of a multidisciplinary, individualized approach to patient care. The Heart Team includes interventional cardiologists, cardiothoracic surgeons, non-invasive cardiologists, echocardiographers, radiologists, cardiac anesthesiologists, nurses, physician assistants, and others who are highly experienced and specialized in treating patients with valvular heart disease.

The entire Team take the time to get to know you and work with you to provide exactly the care you need. This important step helps to determine if you might be a candidate for TAVR, or if heart valve surgery or another treatment may be more appropriate. TAVR is one of several treatment options available for aortic valve stenosis.

What tests are required for evaluation?

Echocardiogram: Ultrasound of your heart to visualize and evaluate the severity of your aortic valve stenosis. This test often needs to be performed at Stamford Hospital because there is the need for dedicated views to fully assess the aortic valve.
Cardiac Catheterization: Also known as an angiogram of your heart, this is used to evaluate the vessels in your heart (coronary arteries) for any blockages.
CT Scan of the chest, abdomen, and pelvis: used to evaluate the size of your vessels in these areas, also measures the area in the heart where the new valve will be placed.
Other ancillary testing including blood work.

What if I already have a bioprosthetic (tissue) valve?

You can still have a TAVR procedure. Bioprosthetic (tissue) heart valves can degenerate over time and can eventually fail. A “valve-in-valve” procedure can be done where the transcatheter aortic valve is implanted into the failed valve, pushing the old leaflets aside.

Why do I need to be seen by a dentist before my TAVR procedure?
Dental work done right after receiving a new heart valve could cause the new valve to become infected. If you have your own teeth and you have not seen a dentist recently, please arrange for an appointment as soon as possible. If you are in need of dental surgery, this should be discussed with your physician. Please let us know as soon as possible. If you need help in making proper arrangements, we will be able to facilitate the process.

How should I prepare?

You'll be given certain instructions to prepare for your TAVR procedure. Your treatment team will discuss with you how to prepare for the procedure and what to expect during the procedure. Connect with your treatment team about any questions you may have about the procedure.

During the tavr procedure

What can I expect during my TAVR procedure?

Currently, most of TAVR access to your heart is performed through blood vessels in your legs. Occasionally, TAVR can be performed through a small incision in your chest, and accessed directly through the left chamber of your heart (left ventricle) or the upper large vessel (aorta or subclavian /axillary artery).

In TAVR, a hollow tube (catheter) is inserted through the access point. Imaging techniques are used to guide the catheter through your blood vessels, to your heart and into your aortic valve.

Once it's precisely positioned, special tools and the replacement valve are passed through the catheter and the replacement valve is delivered into place in the aortic valve. Some valves are expanded on a balloon and others are self-expanding.

Thereafter, we withdraw and remove the catheter.

After the tavr procedure

What will my recovery be like?
After your procedure you will spend 12-24 hours in the intensive care unit (ICU) for close monitoring. You'll then be transferred to the cardiology unit (9th floor) for the remainder of your stay. On average, you can expect to remain in the hospital for a total of 3–5 days. However, depending on your overall health, you may be able to return home in as early as 2 days.

Usually, you'll need to take blood-thinning medications for a period of time (antiplatelet agents) to prevent blood clots after the procedure.
It is recommended that you take antibiotics before certain dental procedures and some other invasive procedures to prevent infections, as you're at higher risk of infection with a replacement heart valve.
You'll need regular follow-up medical appointments. Be sure to notify us if you have any new or worsening signs or symptoms. We recommend that you make healthy lifestyle changes, such as eating a heart-healthy diet, exercising regularly, maintaining a healthy weight and avoiding smoking.

What are the risks of TAVR?
Risks of TAVR need to be evaluated and balanced along with benefits and alternatives. It will be important to specifically tailor the full evaluation to your situation and clinical status. There are risks and benefits as well both in the conservative approach and in the surgical alternative treatment.

The Heart Team will discuss your individual risks and benefits with you.