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5 questions to ask when considering TAVR

Posted on Feb. 4, 2016 ( comments)
Plush heart on hospital bed

If you suffer from severe aortic stenosis (narrowing and obstruction of the aortic valve), your doctor might have recommended a relatively new and innovative procedure called transcatheter aortic valve replacement (TAVR).

Although aortic valve implantation (AVI) through open-heart surgery is the most common way to treat aortic stenosis, not all patients are good candidates for AVI. If you are of advanced age, have serious related conditions or frailty, open-heart surgery could be too risky. In this case, TAVR might be a good option for you.

If you're considering TAVR, here are some of the best questions to ask as you research the procedure.

What kind of experience does your TAVR program have?

More than 250 medical centers now offer the TAVR procedure — but some have better results than others. Research shows a link between the number of TAVR surgeries performed and successful patient outcomes. MultiCare was the first health care system in the South Sound to offer this procedure.

How does the TAVR procedure work?

TAVR is similar to balloon angioplasty, in which a catheter is threaded through an artery toward the heart, and a balloon device on the end inflates to help open a narrowed artery in the heart.

With TAVR, a replacement valve is crimped onto the balloon, which the surgeon positions into place and then inflates. The replacement valve expands, pushing aside the diseased valve and securing into place.

The surgeon or cardiologist will choose one of three possible locations for inserting the catheter: into the femoral artery in the groin, through a large artery in the chest or between the ribs.

TAVR is less invasive than open-heart surgery, and doesn't require the use of a heart-lung machine.

What is the expected recovery for TAVR?

While open-heart surgery can require a 2- to 3-month recovery period, TAVR patients are often released from the hospital after 4–5 days and back to their normal activities within 1–2 weeks.

Patients who had suffered the unsettling symptoms of arterial stenosis — such as dizziness, shortness of breath, heart palpitations, fatigue and fainting — often feel better after the procedure and experience renewed energy.

What is the risk of complications?

Although TAVR offers many benefits over open-heart surgery, results vary depending on the overall health of the patient. And while serious risks are uncommon, they do exist. Some of the well-recognized risks include:

  • Stroke. The chance of stroke in the short term after the procedure is likely in the 2-3 percent range, and is becoming less common.
  • Death. The risk of death during the procedure is low, likely in the <2–3 percent range. The chance could be greater for higher-risk patients.
  • Valve leak. Occasionally a leak occurs around the implanted valve, leading to poor outcomes. But with improved technology, this is becoming less common.
  • Kidney failure. Because contrast dyes are used during the procedure, there is a risk of kidney damage, especially when large amounts of dye is used and when the patient has preexisting kidney failure. Injury to the kidneys is reversible in most cases.

As far as major heart procedures go, TAVR is relatively safe. But it does carry a significant risk of complications that should be discussed with your doctor.

How will my new aortic valve function after the procedure?

Once implanted, your new TAVR valve should function just like a conventionally placed aortic valve, allowing full blood flow through the aorta and reducing symptoms of arterial stenosis. Evidence shows that the TAVR valve is durable up to five years and potentially longer.

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