What you need to know about the TAVR procedure (Transcatheter Aortic Valve Replacement), which replaces a valve without opening the heart

When you hear the word "heart surgery," what comes to mind? Most of the time, we think of a major surgery that involves opening the chest, right? But with the advancement of medical science, there are now much simpler, less risky treatments for some heart problems. Today, we're going to talk about one such new, successful treatment.

What is TAVR? Let's understand it simply.

The full meaning of TAVR is Transcatheter Aortic Valve Replacement . It is sometimes also called TAVI (Transcatheter Aortic Valve Implantation). Both these names refer to the same treatment method.

Simply put, TAVR is a method of replacing the aortic valve of the heart through a very small incision, without opening the chest.

Think of our heart as a water pump in a house. This pump sends blood to the whole body through a main pipe. This main pipe is called the aorta. When blood goes from the heart to this aorta, there is something like a gate that controls that blood flow. That is what we call the aortic valve. If this valve does not open or close properly, serious problems arise in the blood flow to the whole body. TAVR involves replacing the damaged and malfunctioning valve with a new valve.

Who needs the TAVR procedure?

This treatment is most needed for people with a condition called aortic stenosis . That is, the aortic valve we talked about earlier is narrowed. Like a rusty gate, this valve does not open completely.

There are several main reasons why the valve narrows in this way:

• Aging: Often in people over the age of 70, calcium deposits build up in the valve, causing it to thicken and become stiff.
• Other medical conditions: This valve can also be damaged quickly due to conditions such as rheumatic heart disease or certain congenital heart defects (e.g., bicuspid aortic valve).

When the valve narrows, the heart has to work harder than before to pump the amount of blood the body needs. It's like a motor having to pump more water through a clogged pipe. Over time, this extra strain on the heart can weaken the heart muscle, eventually leading to heart failure.

What happens before a TAVR?

Before you undergo TAVR, your doctor will perform several tests to accurately assess your condition. These tests can give a clear picture of how blood is flowing through your heart and whether there are any other problems.

These are the tests that are usually done:

• Blood tests
• Echocardiogram - This is like a scan of the heart.
• Electrocardiogram (ECG)
• CT scan or MRI scan
• Cardiac catheterization - This checks for blockages in the coronary arteries that supply blood to the heart.

After all these tests are done, the doctor will talk to you and explain everything about the treatment, what to expect afterwards, and how you will be given anesthesia. You can ask any questions you may have at this time.

You will be asked to stop eating and drinking 4-6 hours before the treatment. Also, you should ask your doctor if you need to stop taking any medications and when.

How TAVR treatment is performed

This is a very simple procedure. You will be given anesthesia so you won't feel any pain. You will also be given medication to prevent blood clots.

Then, an interventional cardiologist follows these steps:

1. Making a small incision: A very small incision is made, usually near a major blood vessel (femoral artery) in the upper part of your thigh, near the groin.

2. Insertion of the catheter: Through the incision, a very thin, flexible tube called a catheter is passed along the blood vessel all the way to the heart.

3. Installing the new valve: The new valve is taken through this catheter, placed inside your old, damaged valve, and expanded. The new valve is then placed exactly in that place. The old valve is pushed aside by the new one and remains there.

4. Testing: The new valve is checked to see if it is working properly and if there are any leaks.

5. Removal and suturing: If everything is OK, the catheter is carefully removed, the small incision that was originally made is sutured, and a plaster is applied.

Usually, this entire process takes about one or two hours.

What are the benefits of this?

TAVR has many advantages over traditional open-heart surgery.

Despite these advantages, open heart surgery may be more appropriate for some patients. You should discuss with your doctor whether TAVR or open surgery is the best treatment option for you.

Are there no side effects? Let's talk about the risks too

TAVR is a very successful treatment. With advances in technology, complications are now rare. However, as with any medical procedure, there are some minor risks.

• The heart's electrical system is affected, requiring the installation of a pacemaker .
• Bleeding around the new valve.
• Stroke.
• Bleeding.
• Infection.
• Damage to the kidneys, heart, or blood vessels.

Your doctor will explain these risks to you thoroughly. Since this is done by a very experienced medical team, the risks are very low.

Is the TAVR procedure not suitable for everyone?

Although this treatment is very beneficial, it is not suitable for everyone. Your doctor may not recommend TAVR for someone with the following conditions:

• If you have had a heart attack within a month.
• If you have complex congenital heart defects.
• If there are problems with other heart valves (e.g. Mitral regurgitation).
• If you have recently had a stroke or TIA (Transient ischemic attack).
• If you have serious kidney disease.

Your doctor will determine the most appropriate treatment for you based on your overall health condition.

How long does it take to heal?

Most people can go home from the hospital within a day or two after TAVR treatment. The time it takes to fully recover varies from person to person.

• You can usually resume most of your daily activities within a few days.
• You have to wait about a week before doing things like lifting weights.
• You can go to work in about two weeks and drive in about a month.
• It can take between 6 and 10 weeks to fully recover.

Your doctor will advise you on the amount of rest you need, what to do, and what not to do. Following that advice is very important for a speedy recovery.

Additionally, you may be referred to a cardiac rehabilitation program , which is a series of special exercises to strengthen your heart. This will speed up your recovery process.

When do you need to see the doctor?

After TAVR treatment, you will be asked to go for checkups, about once a month and then once a year. These follow-up visits are very important to make sure the new valve is working properly. However, if you experience any of the symptoms below, you should call your doctor right away.

In the event of an emergency such as severe chest pain or severe difficulty breathing , go to the nearest hospital's Emergency Department (ETU) immediately.