You may be a little scared when your doctor tells you that you have a problem with a valve in your heart and that it needs to be replaced. You may be thinking, "Oh, is this a major operation that will open your chest?" It's true that such surgeries are a bit serious and take a long time to heal. But today we're going to talk about a modern technology that allows you to replace a heart valve without such a major surgery, but only through a very small incision. This is called TAVR.
What is TAVR? Let's understand it simply.
The full meaning of TAVR is Transcatheter Aortic Valve Replacement . Sometimes it is also called TAVI (Transcatheter Aortic Valve Implantation). These are the same thing.
Simply put, this involves replacing the main valve in your heart, the aortic valve, without opening your chest.
Think of your heart as a water pump in a house. Just as this pump sends water to the whole house, the heart pumps clean, oxygen-rich blood to the whole body. The main gate through which this blood leaves the heart is the aortic valve . This is like a door that only opens one way. It opens when the blood leaves, and closes when it tries to come back. This is a very important function.
What kind of medical condition requires TAVR surgery?
The main reason for performing a TAVR is a condition called Aortic Stenosis . That means the Aortic valve we talked about is blocked or narrowed . It's like the two doors don't open properly, but only open slightly.
There are several main reasons why the valve can become stuck like this:
- Aging: As you get older, beyond the age of 70, the valve can become thickened and become less effective due to calcium deposits. This is the most common cause.
- Other medical conditions: In some people, this valve can quickly weaken due to conditions such as congenital heart disease (e.g., Bicuspid Aortic Valve) or rheumatic heart disease that develops in childhood.
What happens when the valve becomes blocked like this? The heart has to work very hard to pump blood throughout the body. It's like putting extra load on a motor to pump water through a blocked pipe. When this happens for a long time, the heart muscle weakens, eventually leading to heart failure.
What should be done before a TAVR?
If you decide to have a TAVR, your doctor will perform several tests beforehand to accurately assess the condition of your heart and to get an idea of any potential problems that may arise during the surgery.
Based on these test results, the doctor will make the final decision as to whether TAVR or open-chest surgery is best for you.
| Name of the test | Simply put, what do you do with it? |
|---|---|
| Blood Tests | Things like the general health of the body and kidney function are being looked at. |
| Echocardiogram (Echo Scan) | This is a scan of the heart. They look at how the valves are working and how tight they are. |
| Electrocardiogram (EKG) | The heart's electrical activity (rhythm) is checked. |
| CT Scan or MRI Scan | Three-dimensional (3D) images of the heart and blood vessels are taken to precisely measure the size of the valves and the position of the blood vessels. |
| Cardiac Catheterization | They check for other blockages in the coronary arteries that supply blood to the heart. |
After these tests, the doctor will talk to you about the surgery, the anesthesia, and answer any questions you may have. You will be asked to stop eating and drinking 4-6 hours before the surgery.
How is TAVR surgery performed?
Since this is not a breast augmentation surgery, you don't need to be completely unconscious. In most cases, you will be given a medicine that puts you into a light sleep (sedation). So you won't feel any pain.
The surgery is performed step by step as follows:
1. The interventional cardiologist makes a very small incision in your upper thigh (or possibly elsewhere in your neck or chest).
2. A very thin, flexible tube called a catheter is passed through the incision, along a major blood vessel, and into the heart.
3. It is from within this tube that the new valve is folded into a small piece and placed in the heart where the old, clogged valve is.
4. Once in place, the new valve is expanded. It then snaps into place. The old valve is not removed , it is pushed aside by the new valve.
5. Check to see if the new valve is working properly and if there is any blood leakage.
6. Finally, the catheter is taken out, the small incision is closed with one or two stitches, and a bandage is applied.
The entire process usually takes about an hour or two .
What are the benefits and risks of TAVR surgery?
TAVR has many advantages over traditional open heart surgery.
Main advantages
- No big incision: There's no need to cut the breastbone or remove the ribs. There's only a very small incision.
- Faster healing: Since there is no major injury, there is less pain, less strain on the body, and faster healing.
- Shorter hospital stay: In most cases , you can go home the same day after surgery. You may need to stay for two or three days.
- Suitable for high-risk patients: This method is a very good option for those who are very old, have many other diseases, and cannot tolerate major surgery.
Risk situations
As with any medical procedure, TAVR carries some minor risks. However, with today's advanced technology, the likelihood of these occurring is extremely low .
- The heart's electrical system is affected, possibly requiring the installation of a pacemaker .
- A little blood is leaking from the sides of the new valve.
- Small risk of stroke.
- Bleeding or infection at the incision site.
- Damage to the kidneys or blood vessels.
Your doctor will talk to you about all of this and explain how effective it is for your situation and what the risks are.
Post-surgery recovery and precautions
After the surgery, you will be kept in bed for a few hours to rest. The blood vessels where the incision was made will be clamped to stop bleeding. You will be given medication to prevent infection and to stop blood clotting.
After you go home, avoid lifting or doing strenuous activities for a week or two. You can return to your normal activities in about two weeks. It may take about 6 to 10 weeks to fully recover.
In addition, you will be referred to a cardiac rehabilitation program, which is like a special exercise program prescribed by a doctor to strengthen your heart.
If you have these symptoms, call your doctor immediately!
If you develop any of the following symptoms after returning home, be sure to inform your doctor.
| Symptom | Description |
|---|---|
| Fever | It may be a sign of an infection in the body. |
| Changes in the incision site | Increased pain, bleeding, bruising, redness, or swelling. |
| Chest pain | New or unusual chest pain. |
| Difficulty breathing | Shortness of breath even with slight exertion. |
| Dizziness | Feeling dizzy or faint. |
Take-Home Message
- TAVR is an advanced medical procedure that replaces the aortic valve of the heart through a small incision, without opening the chest.
- This results in less pain, faster recovery, and much less time spent in the hospital.
- This is a great solution, especially for those who are elderly and have other medical conditions and cannot bear the risks of open surgery.
- TAVR may not be right for everyone. It is important to talk to your cardiologist to determine which treatment is best for you.
- Following the doctor's instructions after surgery and attending follow-up appointments on scheduled dates is essential for a speedy recovery.
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