Transcatheter Aortic Valve Replacement (TAVR)
Transcatheter aortic valve replacement (TAVR) is a method used to replace a heart valve without using traditional open-heart surgery. Sometimes traditional open heart surgery is not an option due to a patient’s age, frailty or other medical condition. For these patients, TAVR may be an option.
Swedish is one of the medical facilities in the United States that is staffed and equipped to perform TAVR. In late 2011, the U.S. Food and Drug Administration approved the Edward SAPIEN transcatheter heart valve for the treatment of patients with severe, symptomatic native aortic valve stenosis who were not able to have open-heart surgery. In early 2012, the Centers for Medicare & Medicaid approved coverage of TAVR.
Appointments & Referrals
Physician referral required.
TAVR vs. Open-Heart Surgery
Valve replacement surgery typically is open-heart surgery that requires placing the patient on a heart-lung machine so the heart can be stopped during the four-hour procedure. For some patients, this may be too risky to attempt.
The TAVR procedure differs from traditional valve replacement surgery in the way that the doctor replaces the damaged valve with the new, artificial valve. Rather than opening the chest wall to access the heart and surgically remove and replace the diseased valve, the doctor makes a small incision in an artery in the groin and threads a thin catheter up the artery. The new valve is then moved through the catheter into position across the diseased valve. After ensuring the valve is correctly positioned, the doctor uses a small balloon to open the valve. The new valve, which is about the diameter of a dime when fully opened, immediately takes over responsibility for controlling the blood flow.
The TAVR procedure typically takes about 2 hours. Traditional surgical valve replacement surgery can take up to 4 hours. Other benefits of the TAVR procedure include less blood loss, a lower risk of infection and a faster recovery time.
TAVR at Swedish
The aortic valve replacement team at the Swedish Heart & Vascular Institute includes cardiologists, cardiac surgeons, specially trained nurses and several other specialists who are instrumental in diagnosing and/or treating aortic stenosis.
The team carefully screens each patient to determine which approach is the safest option. Patients undergo a number of tests, including echocardiogram, cardiac catheterization, CT scan, lung function testing and carotid artery ultrasound. The team also evaluates frailty – a formal diagnosis that looks at strength, mobility, nutrition and tissue integrity. For people outside the Seattle area, the team bundles tests so they can be completed during two visits.
If the team determines that a patient can safely undergo surgery, he or she is scheduled for surgical valve replacement (SAVR). Frail or elderly patients who are not good candidates for surgery are scheduled for TAVR. Some patients who are extremely sick or are very petite and have veins that are too small for a catheter may not be candidates for either procedure.