Minimally Invasive Procedure for Heart Valve Replacement

What is a TAVR and how does it help patients get back to normal activity?

You’ve been experiencing fatigue after the simplest of activities, and have now been diagnosed with a serious heart problem. The valve that pumps the blood through your heart isn’t working efficiently. It has thickened and calcified with age and doesn’t open and close the way it should. Your cardiologist has told you the aortic valve will have to be replaced. What does this mean? Will you require major heart surgery that might take months to recover?

For many patients, a relatively new, minimally invasive heart valve replacement procedure is available at Washington Hospital. With this procedure, transcatheter aortic valve replacement (TAVR), patients have a short, one- to two-day stay in the Hospital and return to normal activities within a few days.

“One of the main benefits of TAVR, particularly for older patients (75 years plus), is the elimination of open-heart surgery with the heart-lung machine and a reduction in the recovery period of several weeks,” says Dr. Ramin Beygui, one of two UCSF cardiothoracic surgeons performing the procedure at the Hospital. He and Dr. Teng Lee, also a cardiothoracic surgeon, practice at Washington Hospital, providing academic-level care with the convenience for patients of undergoing surgery in the local community.

How does TAVR work? A new bioprosthetic valve, made from bovine (cow) or porcine (pig) tissue, is placed in the heart, supplanting the existing valve. The insertion is made either through an artery in the groin or through an artery connecting to the heart from the chest. In either instance, only a small incision is made to access the artery, the new valve is inserted and placed over the old damaged valve, and wedged into place, Dr. Lee explains.

The aortic valve must be replaced if it isn’t allowing the blood to come through it efficiently after the heart pumps. Dr. Beygui notes. “Aortic stenosis cannot be treated with medication; the condition requires some type of surgery to replace the valve. If the valve is not replaced, heart failure will occur.”

The method of replacement — whether with TAVR or by open-heart surgery — is determined following a risk assessment of the patient and other factors affecting the aortic valve and the heart. The risk assessment considers the patient’s age and other existing medical conditions, and is conducted by one cardiothoracic surgeon and one cardiologist, as required by the U.S. Food and Drug Administration.

“TAVR is a good option for older patients for whom surgery has a higher risk,” Dr. Lee adds. Open-heart surgery requires a heart-lung machine which may pose a higher risk for older patients. For younger patients when a mechanical valve might be more appropriate, it can only be placed with surgery. However, patients with mechanical valves will need to use blood thinners for the remainder of their lives.

TAVR surgery is comparatively short, only two hours in and out, and requires only moderate sedation. Patients with surgical valve replacements stay in the Hospital for four-to-five days and take up to three months to fully recover. “TAVR is a very good option for older, sicker patients as they recover much more quickly from the procedure. It is important for patients to get up and move around as soon as possible.”

TAVR was introduced in the United States in 2011 and has been in use at UCSF since 2013, according to Dr. Beygui. Washington Hospital has offered TAVR for the past two years. Evaluation of TAVR as compared to other aortic valve replacement options is continuing, Dr. Beygui says. He adds: “I believe TAVR will become the standard for aortic valve replacements when the follow-up studies have been completed.”

To learn more about TAVR and other cardiovascular procedures performed at Washington Hospital, visit whhs.com/Heart.

Next week: Local woman shares her TAVR experience.