Transcatheter Aortic Valve Replacement (TAVR) is a medical procedure designed to replace a diseased aortic valve. This less invasive approach offers an alternative for individuals with a narrowed aortic valve, known as aortic stenosis. During TAVR, a new artificial valve is delivered to the heart via a catheter, typically inserted into a blood vessel in the groin. The new valve expands within the old one, restoring proper blood flow.
Risks During and Immediately After the Procedure
Patients undergoing TAVR may experience complications during or shortly after the procedure. Stroke is a concern, occurring in about 2% of patients within 30 days, with the highest risk in the first 48 hours. This can arise from dislodged debris during catheter manipulation or valve deployment.
Vascular complications at the access site, usually the femoral artery, are also a consideration. These include bleeding and hematoma formation. Specific injuries like vessel dissection or rupture have been reported, though the incidence of major vascular complications has decreased.
Interference with the heart’s electrical system may necessitate a permanent pacemaker. Pacemaker placement has been observed in a notable percentage of TAVR patients. Kidney injury is also a possible complication.
Major bleeding events are common in the early post-procedural period. Studies indicate a significant percentage of cases experience major or life-threatening bleeding within 30 days, often at the access site. The procedure also carries a risk of infection and allergic reactions to contrast dye.
Potential Valve-Specific Issues
Complications can also arise from the implanted TAVR valve. Paravalvular leak (PVL), where blood leaks around the edges of the new valve, is one issue. While mild PVL is observed more frequently compared to surgical valve replacement, moderate or greater leakage rates are typically low. This leakage can sometimes lead to additional strain on the heart.
Structural valve degeneration (SVD) refers to the wear and tear of the bioprosthetic valve over time. This involves irreversible changes to the valve leaflets, such as calcification or tearing, which can impair valve function. Factors like younger patient age, kidney conditions, and abnormal calcium metabolism can contribute to SVD.
Infection of the artificial valve, known as endocarditis, is a serious complication. Its risk is highest within the first 100 days after the procedure.
Valve thrombosis, or blood clots on the valve leaflets, is another potential issue. While clinical valve thrombosis is infrequent, subclinical leaflet thrombosis occurs more often. These clots can impair valve movement and potentially increase stroke risk. The new valve may also lead to coronary obstruction, blocking blood flow to the heart’s own arteries, particularly in valve-in-valve procedures.
Long-Term Considerations and Unknowns
The long-term performance and durability of TAVR valves are areas of ongoing investigation. Comprehensive data extending beyond 5 to 10 years are still being collected, particularly for younger individuals. Bioprosthetic valves have a limited lifespan and are susceptible to gradual degeneration.
The possibility of needing a re-intervention in the future remains a consideration. If the implanted TAVR valve degenerates, a subsequent procedure, such as a valve-in-valve TAVR where a new valve is placed inside the failing one, may be necessary.
Patients who undergo TAVR require consistent medical follow-up, including regular check-ups and imaging, to monitor valve function and overall heart health. This ongoing monitoring represents a long-term commitment. The presence of a previously implanted TAVR valve can also add complexity to any future cardiac procedures. Careful planning for potential lifetime valve management is an important aspect of care, especially for younger patients.