Transcatheter aortic valve replacement
- Article
- 2021-02-27
The aortic valve is one of the four valves that control blood flow in the heart. The aortic valve specifically controls the blood that flows from the heart through your aorta and to the rest of the body. Over time or because of a congenital heart defect, you can develop aortic stenosis - a type of heart valve disease - which is a narrowing of the aortic valve. This narrowing blocks blood flow to your body and forces your heart to work harder. You may need TAVR to replace a diseased aortic valve or to repair a replacement aortic valve that has stopped working. Your doctor may recommend TAVR if you have a medical condition that makes it too risky to replace the valve during open-heart surgery, which is more invasive.
Cardiologists, or doctors who specialize in the heart, usually perform TAVR in a hospital. Prior to TAVR, your medical team will measure the valve opening and then give you medications to relax or put you to sleep, as well as medications that prevent abnormal blood clots. During the procedure, your doctor will route a thin, flexible tube called a catheter to your heart through blood vessels accessible from the groin or thigh, abdomen, chest, neck, or collarbone. Inside the catheter is a folded replacement valve, which your doctor will safely implant into the old valve. Once your doctor is sure that the new valve is correctly placed, he or she will check for leaks and possible complications, such as a problem with the heart's electrical signaling.
After a TAVR procedure, your hospital stay may be shorter and you may be able to return to your daily activities, such as exercising and driving, sooner than with open-heart surgery. However, TAVR carries some risks, including stroke, damage and bleeding where the catheters were inserted; need for a permanent pacemaker due to damage to the heart's electrical signals during the procedure; and injury to the kidneys or heart. Sometimes the new valve leaks because it doesn't fit properly. Your doctor can give you medicine to prevent infection or abnormal blood clots. About a month after the procedure, your doctor will do tests to check how well the valve is working and how well you are healing. You may need follow-up visits every year to keep the valve working as it should.
How it works
There are several ways your doctor can perform TAVR, depending on your health and the condition of your blood vessels. Your doctor usually leads a tube with the replacement valve through a blood vessel in your groin or thigh called the femoral artery.
If your femoral artery is too small or has been damaged by disease, your doctor can route the tube through blood vessels accessible from the chest. This approach is called transapical access. Your doctor can cut into your chest through your sternum or ribs to access the heart directly through the aorta or through the pointed end of the heart called the apex.
Less often, your doctor may route the tube through blood vessels accessible through the abdomen, neck, or collarbone.
- Belly. NHLBI researchers developed this approach, called transcaval access, to make TAVR available to high-risk patients whose leg arteries are too small or diseased for the standard approach. The doctor makes holes in both the vena cava, a large vein in your abdomen, and the nearby aorta. The doctor inserts the tube with the replacement valve first through the vein and then through the aorta to the heart. You may be able to stay awake if the medical team performs this procedure. This type of TAVR approach can be beneficial for women, whose blood vessels are usually smaller than men's.
- Collarbone. Access to the heart from the vessel below the collarbone or collarbone may be an option if you have had heart surgery before or if you have another condition that makes it more difficult to access other parts of the chest.
- Neck. At transcarotid access, your doctor will cut one side of your neck to expose the carotid artery and watch you closely whilehe opens a hole in the artery for the tube. This type of procedure is rare, but can be used when other options don't work.
- Septum. In rare cases, your doctor will reach the faulty valve by passing the tube through a blood vessel from your thigh to the heart and poking a hole through the septum, the wall of tissue that separates the right and left atria of the heart.
Your doctor can also use additional techniques to avoid complications. New approaches to do TAVR are making the procedure available to more patients.
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