Transcatheter Aortic Valve Replacement

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Treatment Overview

Transcatheter aortic valve replacement (TAVR) is a way to replace the aortic valve without open-heart surgery. This procedure is done to treat aortic valve stenosis.

TAVR is often done through an incision (cut) in the groin. But sometimes a small cut is made in the chest. The doctor uses a tube called a catheter and tools that fit inside the catheter. The doctor puts the catheter into a blood vessel and moves it through the blood vessel and into the heart. The artificial valve fits inside the catheter. The doctor then moves the new valve into the damaged aortic valve. The artificial valve expands and takes the place of the damaged valve.

You may have general anesthesia, which makes you sleep during the surgery. Or you may get a sedative that will help you relax.

To see if TAVR might be a choice for you, a team of doctors will check many things about your heart and your overall health. Together you can decide if you want to have the procedure.

  • TAVR may be a choice for you if you can't have open-heart surgery because of other health conditions. You also may choose it if you have a high risk of serious problems from having surgery.
  • Talk with your doctors about the possible benefits and risks for you.
  • Also talk to your doctors about your goals for treatment. Your personal feelings are just as important as the medical facts in deciding whether to have TAVR.

What To Expect After Treatment

You will probably stay in the hospital for a few days.

  • While you are in the hospital, your doctors and nurses will watch you to check how the new valve is working.
  • You will get information from the hospital about diet, activities, and medicine.
  • You will need to have regular checkups with your doctor. When you leave the hospital, your doctor may give you a blood thinner medicine for a few months to prevent blood clots.

Be sure to tell all of your doctors and your dentist that you have an artificial aortic valve. This is important because you may need to take antibiotics before certain procedures to prevent an infection in your heart.

Why It Is Done

TAVR is done to treat narrowing (stenosis) of the aortic valve. This is the valve between your heart and the blood vessel (the aorta) that carries blood to your body. TAVR may also be done to replace an artificial aortic valve.

This procedure might be done for a person who can't have surgery or who has a high risk of serious problems from surgery. For example, it might be an option if you are not healthy enough for open-heart surgery.footnote 1

How Well It Works

This procedure can help people who have aortic stenosis feel better and live longer.footnote 2

For people who can have their valve replaced either with surgery or with TAVR, both treatments work equally well to help them feel better and live longer.footnote 3, footnote 4, footnote 5

But how well this procedure works depends on several things, such as other health problems that a person has. These include other heart problems. Doctors are still learning who might benefit the most from TAVR.

TAVR typically works best for people who have symptoms caused by stenosis and not by other heart problems, such as heart failure or atrial fibrillation.footnote 4, footnote 5

Because TAVR is a newer treatment, doctors don't yet know the long-term benefits or risks. They also don't know how long the valves will last. But research shows that they work well for at least 5 years.footnote 6

What numbers tell us about the benefits

Longer life: Research shows that people who have TAVR can live longer than people with stenosis who don't have their aortic valve replaced.

  • With TAVR, about 69 out of 100 people are alive after 1 year. This means that about 31 out of 100 people aren't.footnote 7 After 3 years, about 46 out of 100 people are alive, and 54 out of 100 aren't.footnote 8
  • Without a valve replacement, about 50 out of 100 people are alive after 1 year. This means that about 50 out of 100 people aren't.footnote 7 After 3 years, about 19 out of 100 people are alive, and 81 out of 100 aren't.footnote 8

Symptom relief: TAVR can help relieve symptoms of aortic valve stenosis. This benefit appears to last for at least 5 years.footnote 6

  • With TAVR, about 75 out of 100 people have mild symptoms of aortic stenosis or no symptoms within 1 year. This means that about 25 out of 100 people have moderate or severe symptoms.footnote 7
  • Without a valve replacement, about 42 out of 100 people have mild symptoms of aortic stenosis or no symptoms within 1 year. This means that about 68 out of 100 people have moderate or severe symptoms.footnote 7

Risks

TAVR doesn't involve open-heart surgery. But the procedure does have serious risks. Some risks last just a short time. Others are long-term.

Risks include:

  • Heart block. This is a problem with the electrical system in the heart. It can cause a slow heart rate. If this happens, a person may need a permanent pacemaker.
  • Injury to the blood vessel used to put the catheter in the heart.
  • Serious bleeding problems.
  • Damage to the heart from the catheter.
  • Heart attack.
  • Stroke.
  • Death.

What To Think About

Complete the special treatment information form (PDF)(What is a PDF document?) to help you understand this treatment.

Talk to your doctors about your goals for treatment.

References

Citations

  1. Otto CM, et al. (2017). 2017 ACC expert consensus decision pathway for transcatheter aortic valve replacement in the management of adults with aortic stenosis. Journal of the American College of Cardiology, 69(10): 1313-1346. DOI: 10.1016/j.jacc.2016.12.006. Accessed March 30, 2017.
  2. Kim CA, et al. (2014). Functional status and quality of life after transcatheter aortic valve replacement: A systematic review. Annals of Internal Medicine, 160(4): 243-254.
  3. Smith CR, et al. (2011). Transcatheter versus surgical aortic-valve replacement in high-risk patients. New England Journal of Medicine, 364(23): 2187-2198. DOI: 10.1056/NEJMoa1103510. Accessed March 26, 2015.
  4. Mack MJ, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER1): A randomised controlled trial. Lancet. Published online March 15, 2015. DOI: 10.1016/ S0140-6736(15)60308-7. Accessed March 25, 2015.
  5. Adams DH, et al. (2014). Transcatheter aortic-valve replacement with a self-expanding prosthesis. New England Journal of Medicine, 370(19): 1790-1798. DOI: 10.1056/NEJMoa1400590. Accessed March 26, 2015.
  6. Kapadia SR, et al. (2015). 5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER1): A randomised controlled trial. Lancet. Published online March 15, 2015. DOI: http://dx.doi.org/10.1016/S0140-6736(15)60290-2. Accessed March 25, 2015.
  7. Leon MB, et al. (2010). Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. New England Journal of Medicine, 363(17): 1597-1607. DOI: 10.1056/NEJMoa1008232. Accessed October 21, 2010.
  8. Kapadia SR, et al. (2014). Long-term outcomes of inoperable patients with aortic stenosis randomly assigned to transcatheter aortic valve replacement or standard therapy. Circulation, 130(17): 1483-1492. DOI: 10.1161/CIRCULATIONAHA.114.009834. Accessed March 25, 2015.

Other Works Consulted

  • Arnold SV, et al. (2014). Predictors of poor outcomes after transcatheter aortic valve replacement. Circulation, 129(25): 2682-2690. DOI: 10.1161/CIRCULATIONAHA.113.007477. Accessed March 25, 2015.
  • Holmes DR Jr, et al. (2012). 2012 ACCF/AATS/SCAI/STS Expert consensus document on transcatheter aortic valve replacement. Journal of the American College of Cardiology, 59(13): 1200-1254.
  • Kapadia SR, et al. (2015). 5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER1): A randomised controlled trial. Lancet. Published online March 15, 2015. DOI: http://dx.doi.org/10.1016/S0140-6736(15)60290-2. Accessed March 25, 2015.
  • Khatri PJ, et al. (2013). Adverse effects associated with transcatheter aortic valve implantation: A meta-analysis of contemporary studies. Annals of Internal Medicine, 158(1): 35-46.
  • Nishimura RA, et al. (2014). 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, published online March 3, 2014. DOI: 10.1161/CIR.0000000000000031. Accessed May 1, 2014.
  • Nishimura RA, et al. (2017). 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease. Circulation, published online March 15, 2017. DOI: 10.1161/CIR.0000000000000503. Accessed March 15, 2017.
  • Otto CM, et al. (2017). 2017 ACC expert consensus decision pathway for transcatheter aortic valve replacement in the management of adults with aortic stenosis. Journal of the American College of Cardiology, 69(10): 1313-1346. DOI: 10.1016/j.jacc.2016.12.006. Accessed March 30, 2017.

Credits

ByHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Martin J. Gabica, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
Elizabeth T. Russo, MD - Internal Medicine
Specialist Medical ReviewerJohn A. McPherson, MD, FACC, FSCAI - Cardiology

Current as ofJune 1, 2017