Who Qualifies For a TAVR Procedure?
Your doctor may recommend a transcatheter aortic valve replacement (TAVR) if you have severe symptomatic aortic valve stenosis.
More than 1.5 million Americans suffer from aortic stenosis, one of the most common and severe valve disease problems affecting individuals of all ages, affecting health and limiting daily activities.
Conditions that someone with aortic stenosis can experience before knowing they need the procedure include:
- Trouble breathing or feeling out of breath
- Difficulty walking short distances
- A lack of energy
- Chest pain
- Feeling lightheaded or dizzy
"These symptoms are signs of the progression of heart valve disease and should not be ignored as they could also be associated with other heart conditions," said Natalie E. Kelley, Valve Program Coordinator at CHRISTUS Health's Louis & Peaches Owen Heart Hospital.
How does someone know that they could be a candidate?
For patients with severe aortic valve stenosis, TAVR is a vital option to be considered. The FDA now allows access to TAVR for all patients, even those with low surgical risk.
"Our goal is to provide the best treatment option for each individual patient," Kelley said. "After careful consideration, our Heart Team will determine which mode of therapy is more appropriate for each patient.
What is TAVR, or Transcatheter Aortic Valve Replacement?
TAVR offers less invasive surgery and shorter recovery time. A replacement valve is attached to a catheter and inserted into the patient's body through a blood vessel, usually through the groin area.
TAVR eliminates the need for a large incision or physically opening the heart to expose the damaged valve. Instead, the replacement is guided into place and expanded where the old valve has malfunctioned.
"This is a great procedure, because it's done primarily for aortic stenosis, which is the valve narrowing and becoming too tight over time," said Dr. John Evans, who is a cardiovascular and thoracic surgeon and TAVR specialist at CHRISTUS Health. "If that valve becomes too tight, the heart has to work extra hard to pump blood, which can cause the heart to fail."
A Patient Story About TAVR: Bonnie Hamilton
"I can just say that the level of care and I'm not saying that because I'm talking to you and you're a mother Frances person, but it's such a personal level of care," Hamilton said.
Bonnie Hamilton received critical Transcatheter Aortic Valve Replacement (TAVR) treatment at Mother Frances Health System in Tyler, TX. Hamilton received the procedure from the valve team of invasive cardiologist Dr. Peter Pitonak.
Hamilton has been dealing with a heart murmur for 40 years. However, her murmur went from mild to severe in a year.
Hamilton had three deep scuba diving trips planned in June with her family that she makes every year and has done so since the 1980s.
A doctor contacted her and said she could go on her three planned vacations but couldn't go deep diving because of her condition and the news devastated her.
"I made all of my trips and had the procedure done and it was amazing," Hamilton said. "The whole hospital, the cardiac unit, everything. I spent one night in the hospital, and that was it."
A half incision was made in the groin for the procedure and Hamilton said the recovery was so easy with no complications.
"I want to give kudos to the cardiac rehab team at the hospital," Hamilton said. "The doctors made me feel very welcomed."
"It's not very often you can talk to someone about scuba diving and they have an enjoyment for it and you're going to go try it. Yeah, they take the time. They take the time to get to know you," Hamilton said.
One year later
A year after her procedure Hamilton was back to living a fulfilling life. In the morning, Hamilton gets on the elliptical for about 20 minutes, lifts weights on five weight machines, and does a 45-minute Zumba class. Hamilton also got to go deep dive once again.
"This year, it was my cousin, my grandson. So, we had a smaller group than usual but I got to go and it was wonderful," Hamilton.
Hamilton said that she would recommend someone who is hesitant about receiving treatment for TAVR to go ahead and do it.
"Just get it done," Hamilton said. "Don't wait for it to progress to the point that you can't make a full recovery."
What is aortic valve stenosis?
Aortic valve stenosis is a heart valve disease. As a result, the lower left heart chamber and the body's main aorta become narrow and don't open fully. This causes blood flow to be blocked or restricted from the heart's aorta to the rest of the body.
This may cause a doctor to recommend the treatment of transcatheter aortic valve replacement, depending on the condition's severity. Without treatment to repair the aortic valve, the limitation of the aortic valve working properly may lead to death.
What is the leading cause of aortic valve stenosis?
Aortic valve stenosis is mainly caused by calcium buildup inside the aortic valve over time. Calcium buildup can cause the valve tissues to be narrow or thick.
Calcium buildup can be caused by wear and tear of the valve due to aging.
What is a transcatheter aortic valve procedure?
A transcatheter aortic valve replacement procedure replaces a damaged aortic valve with heart tissue from a cow or pig. The heart tissue is placed onto an existing biological tissue valve that is not operating functionally.
Transcatheter aortic valve replacement is performed using small incisions and a catheter to reach the heart.
"The reality of needing heart surgery is tough to digest for most patients. The fact it can be done safely through small incisions in certain patients puts them more at ease," Dr. Evans aid.
During the procedure, the doctors will use a catheter and place it into the blood vessel, through the groin or chest area, and will escort it to the heart. The doctors will use x-ray imaging or echocardiogram pictures to help the doctor place the catheter into the correct position.
The cow or pig tissue passes by the hollow catheter and is placed in the area of the aortic valve. A balloon is used on the tip of the catheter to press the new valve into place.
Once this is done, the doctor removes the catheter once the new valve is securely in place.
While the TAVR procedure is ongoing, the treatment team will monitor the vital signs, blood pressure, heart rate rhythm, and breathing.
Who benefits from receiving a transcatheter aortic valve replacement procedure?
Patients aged in their 80s or 90s with this type of aortic valve disease are often not healthy enough to undergo open heart surgery and even medication is not the solution. So, ultimately, they would succumb to heart failure from this valve not being fixed.
TAVR can also be considered for those who suffer from the following:
- Weak heart
- Prior heart surgery
- Prior stroke
- Chronic obstructive lung disease
- Liver disease
- Kidney disease
What happens after a transcatheter aortic valve procedure?
The doctors may keep you a day after the procedure to monitor how your body reacts. Usually, patients who undergo a TAVR procedure go home the next day.
Your doctor will explain how to watch for any signs and symptoms of infection that may include fever, pain, swelling, or leakage of the catheter.
The medications prescribed may consist of blood thinners or antibiotics. Blood thinners may be prescribed to prevent blood clots. Antibiotics may be prescribed to treat possible infections.
The doctor will recommend doctor checkups to perform image testing to know that the valve is functioning properly.
Seek emergency if you have any of the following side effects or symptoms after the procedure that include chest pain, tight chest, shortness of breath, or a fainting feeling.
Who does transcatheter aortic valve replacement impact?
More than 1.5 million Americans suffer from aortic stenosis, one of the most common and serious valve disease problems that can impact individuals of all ages, affecting health and limiting daily activities. Your doctor may recommend TAVR if you have severe symptomatic aortic valve stenosis.
For patients with severe aortic valve stenosis, TAVR is an important option. The FDA now allows access to TAVR for all patients, even those with low surgical risk.
Our goal is to provide the best treatment option for each individual patient. After careful consideration, our Heart Team will determine which mode of therapy is more appropriate for each patient.