Transcatheter Aortic Valve Replacement (TAVR) is a minimally invasive medical procedure that offers an alternative to traditional open-heart surgery for replacing a diseased aortic valve. The transfemoral method, which involves accessing the heart through an artery in the leg, is the most common way this procedure is performed. TAVR aims to restore proper blood flow from the heart to the rest of the body, improving patient well-being.
Understanding Aortic Valve Stenosis
Aortic valve stenosis occurs when the aortic valve, located at the exit of the heart’s main pumping chamber (the left ventricle), narrows. This narrowing restricts blood flow from the heart into the aorta, the body’s largest artery, which then distributes oxygenated blood throughout the body. The heart must work harder to push blood through the narrowed opening, leading to increased pressure and strain on the left ventricle.
Over time, this increased workload can cause the left ventricle’s muscle to thicken and enlarge, potentially weakening it and leading to heart failure if untreated. Individuals with aortic valve stenosis may experience symptoms like chest pain or tightness, particularly with physical activity, due to the heart’s increased effort. Shortness of breath, especially during exertion, and feelings of lightheadedness or fainting are also common as blood flow to the brain is reduced.
The Transfemoral TAVR Procedure
The transfemoral TAVR procedure begins with a small incision, typically less than an inch, made in the groin area to access the femoral artery. A thin, flexible tube called a catheter is then inserted into this artery. This catheter serves as the delivery system for the new artificial heart valve.
Guided by advanced imaging techniques, the catheter is carefully threaded through the blood vessels, navigating up to the heart and precisely positioning it within the diseased aortic valve. The replacement valve, made from animal tissue (often from cows or pigs), is designed to be collapsible. Once at the correct location, the new valve is expanded, pushing aside the leaflets of the old, diseased valve.
The new valve then firmly secures itself within the existing valve’s structure, immediately taking over its function of regulating blood flow. This expansion allows blood to flow freely from the left ventricle into the aorta, alleviating the obstruction caused by stenosis. After confirming the new valve is functioning correctly and positioned accurately, the catheter is carefully withdrawn, and the incision in the leg is closed.
Recovery and What to Expect
Following a transfemoral TAVR procedure, patients can expect a short hospital stay, often one to two days, with some going home the same day. Immediately after the procedure, patients are closely monitored in an intensive care unit to ensure stability. Pain medication can be provided to manage discomfort at the incision site.
Upon returning home, a small bandage will cover the catheter insertion site in the groin. Patients should keep this area clean and dry, washing it gently with soap and water daily. It is normal for the site to appear bruised, slightly swollen, or have a small lump, which resolves within a few days to a couple of weeks.
Activity restrictions are in place for the first few days to a week. Patients should avoid strenuous activities, heavy lifting (over 10 pounds), and prolonged standing. Gradual increases in activity, such as short walks, are encouraged. Follow-up appointments, within 30 days, are scheduled to assess the new valve’s function through an echocardiogram and monitor overall recovery.
Determining Candidacy for TAVR
Determining if TAVR, especially the transfemoral approach, is appropriate involves a comprehensive evaluation by a multidisciplinary heart team. This team includes interventional cardiologists, cardiac surgeons, and other specialists who assess a patient’s health profile. They review diagnostic tests, medical history, and conduct physical examinations to understand the severity of aortic stenosis and any co-existing medical conditions.
Factors considered for TAVR candidacy include the severity of aortic stenosis and whether it is causing significant symptoms like chest pain or shortness of breath. The team also assesses the patient’s overall health, including age and the presence of other medical issues such as lung conditions or previous surgeries, which might make traditional open-heart surgery more challenging. Anatomical suitability of the aortic valve and blood vessels, especially the femoral arteries, is also evaluated to ensure the transfemoral approach is feasible.
TAVR is considered for individuals at an elevated risk for complications from conventional open-heart surgery. The heart team collaborates to determine the most appropriate treatment plan, ensuring that the potential benefits of TAVR outweigh any procedural risks for the individual patient. This personalized assessment aims to select patients who will experience significant improvement in their quality of life after the procedure.