The only suspense after Arnold Schwarzenegger’s recent social media announcement that he had undergone heart surgery for the third time was whether his new aortic valve actually qualified as surgery.

It’s possible that Schwarzenegger, the actor and former California governor who was photographed delivering a thumbs-up from his hospital bed, might have received the valve in a low-impact procedure while he remained partly awake.

This procedure, called transcatheter aortic valve replacement, uses a needle, not a knife, to carry a new valve through an artery in the thigh and wedge it through the original aortic valve. (Mick Jagger of the Rolling Stones had a TAVR procedure in 2019, replacing a narrowed aortic valve that no longer opened properly.)

“Physicians routinely use catheters and balloons to widen and place stents in narrowed heart arteries – a procedure called angioplasty,” says Dr. Raymond G. McKay, Co-Director of the Hartford HealthCare Heart & Vascular Institute Structural Heart Disease Program at Hartford Hospital. “The TAVR technique is similar, but the catheter carries a collapsed replacement valve to the site of the defective valve. It is expanded in place and it takes over the work of the old valve.”

A conventional valve replacement is infinitely more taxing on the body, with an incision extending from the top to the bottom of the breastbone. Doctors must cut through the breastbone, exposing the heart.

TAVR, in fact, was initially approved for at-risk patients unable to withstand open surgery.

“It’s a minimally invasive procedure,” says Dr. McKay. “There is no need to open the chest. The scars are small, and it can be done relatively quickly, compared to open-heart operations. This can mean a shorter recovery time and lower risk of infection.”

Schwarzenegger had two previous heart surgeries, including an open surgery two years ago to replace a pulmonary valve, which helps carry blood from the heart to the lungs. He also had a pulmonary valve replacement in 1997.

One of Schwarzenegger’s social-media posts might have been a giveaway that he underwent a TAVR procedure at the Cleveland Clinic:

“I feel fantastic and have already been walking the streets of Cleveland enjoying your amazing statues.”