What TAVR Means for Low-Risk Heart Valve Replacement Patients

1,000th TAVR
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Download your free informational guide on the TAVR procedure. 

Not too long ago, a diagnosis of severe aortic stenosis invariably resulted in open-heart surgery to install a replacement valve, followed by a recovery calculated in weeks and months.

Now, a remarkable new procedure (not surgery) replaces a leaky aortic valve by guiding a metal-mesh valve through blood vessels using a catheter inserted into a small incision in the groin. After the procedure, performed with the patient under local anesthesia, the expected recovery time is about a week.

Transcatheter Aortic Valve Replacement, or TAVR, was approved in 2011 by the Food and Drug Administration for patients too frail for open-heart surgery. Most patients with severe aortic stenosis, a hardening of the aortic valve, are typically males in their 70s or older. After encouraging results in studies of intermediate-risk patients, the Heart & Vascular Institute at Hartford Hospital is now one of 35 hospitals nationwide participating in a study that allows TAVR for low-risk patients. (See video below.)

Hartford Hospital has performed more than 800 successful procedures — the foundation of one of the biggest TAVR programs in New England. Hartford Hospital physicians have served as principle investigators in several national trials documenting the safety and efficacy of TAVR, leading to the FDA’s approval for the procedure in extreme-risk, high-risk and intermediate-risk patients. Already, Hartford Hospital has performed more than 100 successful TAVR procedures in intermediate-risk patients, with no fatalities or serious complications.

Aortic stenosis, often related to age, can be caused by mineral deposits (calcium) on the aortic valve’s leaflets. Eventually, the leaflets stiffen and lose their capacity to open completely, making it more difficult for the heart to pump blood through the aortic valve to feed the rest of the body. Because blood now reaching the brain contains less oxygen, it can cause symptoms like shortness of breath, lightheadedness, fatigue and chest pain. Smoking, high cholesterol and high blood pressure can also contribute to aortic stenosis.

Conventional open-heart surgery to replace the aortic valve usually requires an incision across the sternum (breast bone), a heart lung machine that takes over for the patient’s heart during the procedure and the removal of the diseased aortic valve. In a TAVR procedure, an interventional cardiologist works with a cardiothoracic surgeon, guiding a new valve through an incision in the leg as the patient’s heart beats. The new valve is placed within the diseased aortic valve.

TAVR FAQ

Q: What is TAVR?
A: TAVR, or Transcatheter Aortic Valve Replacement, is performed on patients with aortic stenosis, initially only those classified as high risk or inoperable. All patients are carefully evaluated by a Heart Team comprised of interventional cardiologists, cardiothoracic surgeons, imaging specialists, advanced practitioners, and nurses to see if they are candidates for traditional surgical aortic valve replacement or if TAVR would be the best treatment option.

Q: When did Hartford HealthCare begin offering TAVR?
A: January 2012 at Hartford Hospital.

Download your free informational guide on the TAVR procedure. 

Q: When was TAVR approved by the Food and Drug Administration?
A:  The FDA approved the SAPIEN Transcatheter Heart Valve in November 2011 for the treatment of patients with severe aortic valve stenosis who have been determined by a cardiac surgeon to be inoperable for open aortic valve replacement. In August 2016, the FDA expanded the use of TAVR for patients at intermediate risk for surgery.

Q: Who performs a TAVR procedure?
A:  TAVR is a collaboration between an interventional cardiologist and a cardiothoracic surgeon.

Q: What is aortic stenosis?
A: Aortic stenosis, often related to age, can be caused by mineral deposits (calcium) on the aortic valve’s leaflets. Eventually, the leaflets stiffen and lose their capacity to open completely, making it more difficult for the heart to pump blood through the aortic valve to feed the rest of the body. Because blood now has less oxygen, it can cause symptoms like shortness of breath, lightheadedness, fatigue and chest pain.

An estimated 2.5 million people over age 75, or more than 12 percent of that demographic in the United States, have aortic stenosis. And 80 percent of adults with the disease are male. An estimated 50 percent of people with severe aortic stenosis will die, on average, within two years if they do not have their aortic valve replaced.

Q: How is aortic stenosis diagnosed?
A: Your doctor can use several tests, starting with an evaluation of your heart through a stethoscope. An echocardiogram, which uses ultrasound waves to produce video images, provides more definitive evidence. Only a hospital with a TAVR program, such as Hartford Hospital, can evaluate you for both TAVR and open heart surgery. Before a TAVR procedure, your doctor also might use cardiac catheterization to check your heart arteries (coronary, abdominal and pelvic) for blockages. A CT scan also can determine if your arteries can accommodate a new valve delivered via a catheter. We also evaluate your lung function and assess narrowing or plaque buildup in your carotid arteries.

Q: What is the difference between TAVR and open-heart surgery?
A: Conventional open heart surgery to replace the aortic valve usually requires an incision across the sternum (breast bone), a heart-lung machine that takes over for the patient’s heart during the procedure and the removal of the diseased aortic valve. This procedure is done under general anesthesia. In a TAVR procedure, an interventional cardiologist works with a cardiothoracic surgeon, guiding a new collapsible valve through an incision (usually in the leg) as the patient’s heart beats. The new valve is placed within the diseased aortic valve. When it is expanded, it pushes the old valve leaflets out of the way and assumes responsibility for regulating blood flow. More than 90 percent of patients treated at the Heart & Vascular Institute since October 2015 received their new heart valve through Conscious Sedation or MAC (Monitored Anesthesia Care). They did not require general anesthesia for their procedure. This helps facilitate a faster recovery.

Q: How long does a TAVR procedure take?
A: The time required will depend on your health and the approach used by your doctors: transfemoral, subclavian or transcarotid. The procedure usually lasts 1.5 hours. The average open heart surgery lasts about four hours.

Q: How long is recovery from TAVR?
A: TAVR patients spend about three days in the hospital. Recovery from a TAVR procedure is typically about a week, compared with three months for a surgical-valve replacement.

Q: How long will the new heart valve last?
A: Because of the many variables in assessing a valve’s lifespan, your Heart Team will usually instruct you to follow up with your clinical cardiologist regularly to assure the valve is functioning properly. We use echocardiograms to monitor the valve.

Download your free informational guide on the TAVR procedure. 

 

 

 


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