Transcatheter Aortic Valve Replacement for Aortic Stenosis
Ground-Breaking Treatment Provides New Options for Aortic Valve Stenosis Patients
Aortic stenosis is a condition where the aortic valve that leads blood from the heart to the rest of the body becomes obstructed. For patients with aortic stenosis who are at moderate, high or extreme risk for surgical aortic valve replacement, transcatheter aortic valve replacement (TAVR) is an effective option. University Hospitals Harrington Heart & Vascular Institute cardiologists are among the first in the country to use a fully percutaneous, conscious sedation approach for TAVR. What was previously major open-heart surgery is now being performed minimally invasively on an awake and talking patient with excellent results.
UH Harrington Heart & Vascular Institute at University Hospitals Cleveland Medical Center is recognized as a high-volume Center of Excellence and the first training site for the minimalist, percutaneous conscious sedation TAVR approach for other centers in the U.S. In fact, UH Cleveland Medical Center’s leadership on optimal transcatheter aortic valve replacement practices is recognized internationally, with our physicians teaching this procedure all over the world.
What is TAVR?
TAVR is a nonsurgical procedure performed with local anesthesia in which a special catheter (hollow tube) is threaded into a blood vessel through the groin and guided inside the heart. This procedure is much less invasive than open heart surgery and enables the implantation of a new heart valve without the need of opening the chest. Replacing a severely stenotic (narrow) aortic valve can deliver quality and quantity of life to patients.
There are many significant benefits for patients who qualify for TAVR, including:
- Light sedation and local anesthesia
- Minimal blood loss compared with open valve repair
- Lower respiratory and cardiac complications
- Fewer days in intensive care
- Shorter time in the hospital
- Faster recovery
Which Patients are Right for TAVR?
Transcatheter aortic valve replacement is indicated for patients with severe native aortic valve stenosis and patients with failed bio-prosthetic surgically implanted aortic valves.
TAVR is approved as a less invasive alternative to open heart surgery for moderate and high surgical risk patients. TAVR is also approved for patients who cannot undergo open heart surgery due to poor heart conditions and other health problems that make open heart surgery too high risk (prohibitive surgical risk patients).
Low surgical risk patients may also be TAVR candidates if they are enrolled in a clinical study comparing TAVR with a self-expandable valve versus surgical aortic valve replacement in this particular patient subset. UH Cleveland Medical Center was the first in the U.S. to implant the Evolut R self-expandable valve, and is the only hospital in Northeast Ohio offering low surgical risk patients this opportunity.
Our team will evaluate you to determine your candidacy for the procedure. The surgical risk is based on a number of factors, including prior surgeries, presence of other diseases, age and your overall physical condition. You will meet with our team of interventional cardiologists, cardiac surgeons and specially trained nurses.
What testing will you need to have to determine your eligibility?
- An echocardiogram (ultrasound) of your heart will assess heart valves and function. Your cardiologist may have already done this test. There is no preparation for this test.
- You will be scheduled for a heart catheterization to evaluate the blood flow to your heart muscle. This test will require you to have recent blood work and you may need to stop certain medications to prepare. The night prior to the test you should not have any food or drink.
- You will be scheduled for a special computed tomography (CT) scan to assess your heart valve and also evaluate the condition and size of the blood vessels that will be used to insert the valve. Our team will schedule this test and you may need to have blood work prior to scheduling this test.
- There will be periodic blood work done.
- There may be additional tests recommended.
What are the outcomes for TAVR?
UH Cleveland Medical Center is the leader in the U.S. on the minimalist approach to TAVR, which enables us to perform the procedure under local anesthesia and minimum sedation. This approach ultimately benefits patients, reducing their length of stay at the hospital and reducing potential complications related to general anesthesia, while keeps high standards of efficacy.
TAVR has shown to be markedly superior to medical management in ineligible surgical patients, and equivalent or better than open heart surgery in high-risk surgical patients.
For moderate risk surgical patients, TAVR has been demonstrated to be equivalent to open heart surgery at one year follow-up.
What to expect post procedure?
Most of our patients stay in the hospital approximately 48 hours. The first night you will stay in the Cardiac Intensive Care Unit (CICU). Some patients are able to go home the next day.
Our team will continue to assess your home going needs. Remember, this is not a surgical procedure: therefore you should be able to do most of your activities once back home, but will need some assistance for at least one week.
Your home-going support should be family members or friends that can assist you continuously for approximately five days with things such as meal preparation and household duties. Once you are able to bath and dress yourself comfortably along with basic meal preparation and getting around the house (i.e. take stairs) without assistance, your support system and care partner can allow you to be more independent.
You will return for a visit with our team at one week, 30 days and one year. You should also schedule follow-up appointments with your cardiologist and/or primary care provider. After discharge, we may facilitate cardiac rehabilitation or physical therapy appointments.
Timelines for symptom relief and amount of improvement after the procedure may vary. Some patients start feeling improvement as early as one week, and at one month post-procedure most patients feel significantly better. Combining physical therapy or cardiac rehabilitation as part of the recovery process may further enhance the overall improvement.
To schedule an appointment or refer a patient, call our TAVR patient program coordinator at 216-844-2534.
For more information, call our program nurse manager, Angela Davis, RN, BSN, MSM-HC, at 216-844-6138.