Transcatheter Aortic Valve Replacement (TAVR) offers a less invasive approach to replacing a narrowed aortic valve, known as aortic stenosis. This procedure involves inserting a new valve through a catheter, typically in the leg, guiding it to the heart, and expanding it within the existing diseased valve. TAVR is an option for many, especially those for whom traditional open-heart surgery poses higher risks. While effective, TAVR is a significant medical intervention with potential complications. Understanding these outcomes helps patients and families make informed decisions.
Pacemaker Implantation After TAVR
A common concern following TAVR is the potential need for a permanent pacemaker. This complication arises because the new valve’s frame, when positioned, can press upon the heart’s natural electrical conduction system. This system, responsible for coordinating heartbeats, lies in close proximity to the aortic valve. Compression or irritation can disrupt the normal flow of electrical signals, leading to a slow heart rate or complete heart block.
When the heart’s electrical rhythm becomes too slow, it can cause symptoms like dizziness, fatigue, or shortness of breath. In such cases, a permanent pacemaker may be implanted to regulate the heart’s rhythm and ensure it beats at an appropriate pace. The incidence of new pacemaker implantation after TAVR varies, but it is observed in approximately 10% to 20% of patients. This procedure is typically less invasive than the initial TAVR, often performed under local anesthesia.
Receiving a pacemaker allows individuals to return to a normal, active lifestyle. The device continuously monitors heart activity and delivers electrical impulses only when needed, supporting the heart’s ability to pump blood effectively. Pacemaker implantation is a well-established and safe procedure.
Stroke and Vascular Complications
Stroke represents a serious potential complication associated with TAVR, though its incidence has decreased with advancements. During the procedure, small fragments of calcium from the diseased valve or plaque from the aorta can dislodge. These particles may travel to the brain, obstructing blood flow and leading to an ischemic stroke. The highest risk for stroke occurs during the TAVR procedure and in the immediate period following it.
Vascular complications at the catheter insertion site are also a concern. The femoral artery in the groin is the most common access point for TAVR, requiring large catheters. Potential issues include bleeding, hematoma formation (a collection of blood outside vessels), or damage to the artery itself, such as dissection or pseudoaneurysm.
While these vascular access site complications are common, many are manageable with conservative measures or minor interventions. Advanced imaging and refined techniques continue to reduce their occurrence. Close monitoring of the access site after the procedure helps in early detection and management.
Paravalvular Leak and Valve Durability
Proper sealing of the new valve within the native aortic annulus is important, but a paravalvular leak (PVL) can occur. This is a leakage of blood around the outer edge of the valve frame, not through the valve itself. Mild paravalvular leaks are common after TAVR and often do not cause significant problems.
However, moderate to severe paravalvular leaks can lead to symptoms such as shortness of breath or contribute to heart failure, potentially necessitating further monitoring or a repeat procedure. The occurrence and severity of PVL have decreased with improvements in valve design and sizing techniques. Careful pre-procedural imaging and precise valve deployment aim to achieve optimal sealing.
Regarding valve durability, a common question is how long the TAVR valve will function effectively. TAVR is newer than traditional surgical aortic valve replacement (SAVR), so long-term data beyond 10-15 years is still being collected. Current studies tracking patients for five to ten years indicate excellent durability, with TAVR valves performing comparably to surgical bioprosthetic valves. Ongoing research aims to establish the long-term performance of these devices.
Kidney Injury and Infection Risks
Acute kidney injury (AKI) is a potential complication after TAVR, mainly due to contrast dye used during imaging. This dye, necessary for visualizing blood vessels and valve placement, can be taxing on the kidneys, especially for those with pre-existing kidney dysfunction. While often temporary and mild, it can be more severe, requiring close monitoring or, rarely, temporary dialysis. Hydration strategies and minimizing contrast volume reduce this risk.
The risk of infection, though rare, is a serious consideration following any invasive procedure involving prosthetic material. Infective endocarditis, an infection of the heart valve itself, is the most concerning infection related to TAVR. This condition can be severe and may require prolonged antibiotic treatment or repeat surgery. Healthcare providers emphasize preventive measures, such as maintaining good oral hygiene, to minimize bacteria that could colonize the new valve. Close monitoring for signs of infection after discharge is important.