Your aortic valve sits at the exit of your heart’s main pumping chamber, opening with each heartbeat to let blood flow out to your body. When this valve becomes narrowed and stiff—a condition called aortic stenosis—your heart must work extremely hard to push blood through the tight opening. This causes chest pain, shortness of breath, fainting, and eventually heart failure. For decades, the only treatment was open-heart surgery to replace the diseased valve. But TAVR—transcatheter aortic valve replacement—offers an innovative, less invasive option.
A doctor threads a catheter through an artery in your groin or makes a small incision between your ribs, delivering a new valve that expands inside the old one, pushing it aside and taking over its job. You’re under general anesthesia or deep sedation during the 1–2 hour procedure. Most people go home within 2–3 days and feel dramatically better within weeks as their heart no longer struggles against a severely narrowed valve.
Overview
TAVR replaces a diseased aortic valve without opening your chest. A new valve, compressed onto a catheter, is delivered through blood vessels or through a small incision. Once positioned, the new valve expands and immediately starts working.
Your aortic valve normally opens wide with each heartbeat. In aortic stenosis, the valve becomes thick, stiff, and narrow—usually from calcium deposits. Your heart struggles to push blood through this tight opening.
The new valve—made of animal tissue mounted in a metal frame—collapses small enough to fit on a catheter. The catheter goes through an artery in your groin or through a small cut between your ribs. Once positioned inside your old valve, the new valve expands, pushing the old leaflets aside and taking over their job.
The procedure takes 1–2 hours. Most people go home in 2–3 days and feel better within weeks.
Who Needs This
- You’re a candidate if you have severe aortic stenosis causing symptoms like shortness of breath, chest pain, fainting, or heart failure.
- Your narrowing must be severe, confirmed by heart ultrasound. Mild or moderate stenosis doesn’t need treatment yet—just monitoring.
- Originally TAVR was only for patients too sick for traditional surgery. Now it’s an option for almost anyone needing valve replacement. A heart team—surgeons and cardiologists together—evaluates whether TAVR or surgery is better for you.
- Factors favoring TAVR include older age, multiple health problems, previous chest surgeries, or frailty. Factors favoring surgery include younger age and certain valve shapes where TAVR doesn’t work as well.
- Your valve anatomy must be suitable. CT scans show whether your valve is the right size and shape for TAVR.
Preparing for the Procedure
- You’ll have detailed imaging—heart ultrasounds and CT scans—to measure your valve and plan the procedure. Blood tests check your kidney function and blood counts.
- Usually you’ll have heart catheterization beforehand to check your coronary arteries. Any significant blockages are often treated with stenting first.
- Your doctor reviews your medications and tells you which to take or stop. Don’t eat or drink anything after midnight before your procedure.
- Complete any needed dental work beforehand. After you get the new valve, you’ll need antibiotics before dental procedures.
- Arrange for someone to drive you home and stay with you.
- Plan for a 2–3 day hospital stay.
What Happens During the Procedure
- Most TAVR procedures go through an artery in your groin. You’re put to sleep or deeply sedated. A catheter is inserted into the artery and threaded up to your heart.
- Sometimes groin arteries are too small or diseased. Then doctors use a small incision between your ribs or in your chest.
- A balloon catheter crosses your diseased valve and inflates, splitting open the calcium-stiffened leaflets. The new valve, compressed on a catheter, is positioned where the old valve sits.
- Your heart might be paced very rapidly for a few seconds during valve deployment. This temporarily slows blood flow so the valve doesn’t get pushed out of position.
- The new valve expands—either by inflating a balloon inside it or by self-expanding when released. It immediately begins opening and closing with each heartbeat.
- Doctors check with ultrasound to confirm it’s positioned correctly and working well. If there’s leaking around the edges, they might expand it more.
- The whole procedure takes 1–2 hours.
After the Procedure
- You wake up in intensive care or a specialized cardiac unit. If the groin approach was used, keep that leg straight for several hours.
- Most people feel dramatically better almost immediately. After months or years of struggling against a narrow valve, your heart suddenly has a wide-open path.
- You typically stay 2–3 days. Some healthy patients go home the next day.
- In some patients, the heart’s electrical system can be affected by the new valve’s position, which may slow the heart rate. In such cases, a permanent pacemaker might be needed. This occurs in about 10–20% of patients, but the majority do not require a pacemaker, and imaging plus careful technique help reduce this risk.
- You’ll take blood thinners for 3–6 months, then usually just aspirin.
Recovery at Home
Recovery is remarkably fast compared to open-heart surgery.
- The first week, walk around but avoid heavy lifting and strenuous activity. Most people feel significantly better within 1–2 weeks.
- Take all medications as prescribed, especially blood thinners.
- Watch for warning signs: fever, increasing shortness of breath, chest pain, or signs of infection at the puncture or incision site.
- You can usually drive after about a week and return to work within 1–2 weeks for desk jobs.
- Follow-up appointments happen regularly with heart ultrasounds to monitor the valve.
What to Expect
- The procedure succeeds in over 95% of cases. Immediate symptom relief is common—most people feel better within days to weeks. Shortness of breath improves, energy returns, and activities that were impossible become easy.
- The new valve typically lasts 10–15 years or longer. If it eventually wears out, another valve can often be placed inside it.
- About 5–10% of people have some leaking around the valve edges. Small amounts are usually harmless.
- Most people return to all their normal activities once recovered. Exercise is encouraged.
- Complication rates are generally low, and your heart team evaluates your individual risks carefully to minimize them. Most patients undergo the procedure without major issues.
Possible Problems
TAVR is safe, but complications can happen.
- Stroke occurs in about 2–4% of procedures when calcium or blood clots dislodge and travel to the brain.
- Bleeding at the access site happens in some people, occasionally requiring transfusion.
- Blood vessel damage can occur from the large catheters, especially in people with diseased arteries.
- Kidney damage from contrast dye can happen, particularly in those with existing kidney problems.
- The valve might not position correctly or might leak too much around the edges, occasionally needing additional procedures.
Living with Your New Valve
- Your new valve is permanent and will last many years. You’ll need antibiotics before dental procedures for life to prevent valve infection. Always tell dentists you have a prosthetic valve.
- Annual heart ultrasounds monitor valve function. Report any new symptoms immediately.
- Most people can do all their normal activities. The valve doesn’t set off metal detectors.
- Blood thinners are needed for 3–6 months, then many people stop them unless they have other reasons to continue.
- Watch for signs of valve infection—prolonged fever, chills, night sweats, or unusual fatigue.
Key Points
- TAVR replaces a severely narrowed aortic valve without open-heart surgery. A new valve is delivered through a catheter in your groin or through a small chest incision, expands inside the old valve, and immediately starts working.
- You’re a candidate if you have severe aortic stenosis causing symptoms. A heart team determines whether TAVR or traditional surgery is better for you.
- The procedure takes 1–2 hours. Most people go home within 2–3 days.
- Symptom relief is dramatic. Most people feel much better within days to weeks—breathing improves, energy returns, and quality of life increases significantly.
- Recovery is much faster than open-heart surgery. Most return to normal activities within 1–2 weeks.
- The new valve lasts 10–15 years or longer. You’ll need antibiotics before dental procedures for life and yearly heart ultrasounds to monitor the valve.
- Blood thinners are needed for 3–6 months, then usually just aspirin unless you have other reasons for blood thinners.
Reference: TAVR
