Transcatheter aortic valve replacement (TAVR), also called transcatheter aortic valve implantation (TAVI), is a minimally invasive procedure to replace a diseased aortic valve. It is used to treat severe aortic stenosis, a type of valve disease in which the aortic valve becomes narrowed over time, reducing blood flow from the heart into the aorta.
Aortic valve stenosis is progressive and can quickly become life-threatening. Without treatment, just two years after the first symptoms appear, the survival rate is as low as 50%.
The TAVR procedure may be a good treatment option for you if you have severe aortic stenosis and you're considered high-risk or are too sick for standard valve replacement surgery. It was initially only for high-risk patients but is now approved even for appropriate low-risk patients.
Through clinical trials, RUSH is able to offer TAVR as a potential option for anyone with severe aortic stenosis — even if you aren't experiencing symptoms, and if you are a good candidate for valve replacement surgery.
Because it is not open heart surgery, patients who have TAVR usually recover quickly and have shorter hospital stays than those who have traditional aortic valve replacement procedures.
What Happens Before, During and After a TAVR Procedure?
If you have been diagnosed with aortic stenosis, your doctor may refer you to a cardiologist who specializes in treating heart valve diseases, like the structural heart experts at RUSH.
At the medical center, interventional cardiologists and cardiac surgeons pool their expertise to diagnose and treat aortic stenosis. You will have any necessary diagnostic tests, meet with the team and receive a customized treatment plan — all during the same visit.
For testing, you’ll have a cardiac catheterization. This is a procedure where a small tube is inserted through a blood vessel into the heart, which will help diagnose any cardiovascular problems. You’ll also need a special CT scan of your chest and abdomen.
The standard treatment for severe aortic stenosis is to remove the valve with open heart surgery. But the TAVR procedure does not require the chest to be opened surgically, and the diseased valve is not removed.
Here's how it works:
- The interventional cardiologist threads a collapsible replacement valve up to the heart using a catheter. The catheter is inserted through a tiny incision in either the groin or chest, depending on which entry point offers the easiest and safest path to the valve site.
- Instead of removing the faulty valve, the replacement valve is wedged into the valve site.
- The new valve expands to fit snugly inside the natural aortic valve once the catheter is pulled back, pushing the flaps of the natural valve aside.
- The replacement valve takes over the vital job of controlling blood flow away from the heart and preventing regurgitation (when blood mistakenly flows back into the heart).
During the TAVR procedure, you’ll be sedated. Most patients do not need to have a breathing tube while they’re under sedation.
The procedure itself usually takes about one to two hours.
Afterward, you’ll be transferred to a recovery room and monitored. Most patients only spend one night in the hospital, but some stay a bit longer.
About a week or two after the procedure, you’ll have a follow-up with our advanced practice registered nurses. Then, about a month after the procedure, you’ll be seen by your physician to check on your health and progress.
Once the diseased valve is replaced, symptoms — including chest pain (angina) and shortness of breath (dyspnea) — should go away, and the prognosis is good.
Meet our transcatheter aortic valve replacement (TAVR) providers
Am I a Good Candidate for a TAVR Procedure?
Many factors go into the decision about which valve repair/replacement procedure is right for you, including your age, overall health and personal health goals.
Following are some reasons TAVR may be a good option:
- You are too frail to undergo standard surgery.
- You have other medical conditions that make you a higher risk for open heart surgery, including a prior heart attack, a failing left ventricle, lung disease or kidney disease.
- You had a bioprosthetic valve implanted in the past that is now failing, causing symptoms, and you have a high or greater risk with surgical valve replacement.
But through clinical trials, any patient with aortic stenosis is now eligible to be considered for a TAVR procedure at RUSH, including the following:
- People who have severe, calcific aortic stenosis but do not have symptoms
- Those with severe narrowing of the aortic valve who are considered low-risk for standard surgical aortic valve replacement
Second Opinions for TAVR at RUSH
If your physician has recommended TAVR or another procedure to treat aortic stenosis, you may want to consider a second opinion to explore your options.
Our heart and vascular team can perform a thorough evaluation and work with you to provide a second opinion on your care.
To get started, call RUSH at (888) 352-7874. Our care coordinators will help you schedule your appointments.
RUSH Excellence in TAVR Procedures
- Expertise you can trust: RUSH specialists in and around Chicago have decades of experience helping to develop new treatments for heart valve disease, including aortic stenosis. This includes participating in clinical trials that led to TAVR receiving FDA approval, as well as new types of valves, including the Edwards SAPIEN valve and Medtronic CoreValve.
- Same-day treatment plans: You will meet with a team of specialists — including an interventional cardiologist and a cardiac surgeon — at the same time. For your convenience, the team will customize a treatment plan and present it to you during that same visit.
- State-of-the-art facilities: TAVR and other procedures used to treat aortic stenosis take place in RUSH's interventional platform at our Chicago location. It’s a multi-use space where surgical and catheter-based procedures can happen together. This allows specialists to collaborate more easily and ensure convenience for patients and families.
- Among the best in the U.S.: U.S. News & World Report includes RUSH on its Best Hospitals Honor Roll and ranks our cardiology program among the best in the nation.
FAQs About TAVR
Traditional aortic valve replacement involves open heart surgery to treat aortic stenosis. The surgeon must open the chest, remove the diseased valve and replace it.
TAVR, on the other hand, is minimally invasive. It is performed using a catheter, or small tube, that runs through the artery. It only requires a small incision in the groin or chest. The synthetic replacement valve is then inserted through the catheter and placed in the diseased valve before being expanded like a balloon. The diseased valve is not removed. There is no surgery involved.
TAVR is not surgery because it is performed through a catheter and is considered minimally invasive. But it is a major procedure that involves putting a replacement heart valve in your body. Patients can usually go home after a night of recovery in the hospital, then come in for follow-up visits to monitor their health.
The actual TAVR procedure only takes about one to two hours to complete. But you will need to stay in the hospital for a night or two to recover.
Any heart or valve procedure can carry a risk of complications, but these are uncommon with TAVR procedures. Some of the possible complications include stroke, the need for a pacemaker, bleeding or injury to the artery where the valve is placed.
Your life expectancy after TAVR depends on the age when you have the procedure. But in general, the life expectancy of a person who has TAVR is the same as another person of the same age who does not have aortic stenosis.
The heart is not stopped during a TAVR procedure. But it is sped up to about 140-180 beats per minute while the replacement valve is expanded.
