Have you heard about TAVR? What about TAVI? If it seems like they’ve become popular terms in healthcare lately, that’s because they have, and for good reason. But just what exactly are they? Sure, you probably know that someone is talking about a heart treatment option when they mention them, but do you really know what they mean?
Not to worry – I’ll explain, and I’ll make it straightforward enough that you don’t need an M.D. after your last name to follow along. So, what are TAVR and TAVI? Well, they stand for transcatheter aortic valve replacement and transcatheter aortic valve implantation, respectively. Right, that old thing. Yes, we said “thing,” not “things,” because they’re actually one and the same procedure.
Look at that – you already have half as much to learn as you thought you did. Told you ‘Id make this easy!
A Valve within a Valve
TAVR (I’ll skip the optional TAVI name for simplicity’s sake from here on out), is a minimally invasive surgical procedure that repairs a person’s valve problem without removing the existing, damaged valve. So, when we say “minimally invasive,” we mean it! The old valve never even comes out of you. It stays put just where it is.
You’re probably wondering then, how exactly the procedure corrects the problem. Well, it involves a replacement valve being wedged into the native aortic valve’s place. And just like that, you’ve got a new, working valve for the ol’ ticker. Pretty neat, huh?
The heart is a complex organ, though, and it serves a vital function that you obviously can’t survive without. Getting a new valve in there without disrupting the heart’s functions seems like a tricky feat to pull off. Thankfully, no one but highly trained cardiologists and surgeons handle that.
Still, even for a highly trained and experienced cardiologist, getting it in there is an amazing feat of modern medical science. The way it works is your cardiologist will takes a fully collapsed replacement valve and delivers it to the existing valve location through a hollow tube called catheter. Obviously, a collapsed valve wouldn’t be able to do its job all that well, so the procedure isn’t done just yet. At this point, the new valve is expanded, and it moves the old valve out of the way so that the new valve’s tissue can get down to its new 9 to 5 gig (and also 5 to 9 – it’s kind of married to its job) of regulating blood flow.
So, How Is This Different from Standard Valve Replacement?
“But, hey, wait a minute,” you might be saying. “Doctors have been replacing heart valves for a long time now. I’ve seen medical dramas! You can’t fool me into thinking this is a new concept.” Ooh, which ones are your favorites? I have to put ER and House near the top of my all-time list, personally. But that’s just me.
Anyway, you’re right about heart valve replacements, but TAVR is a fairly new approach to it. The FDA only somewhat recently approved it for people with symptomatic aortic stenosis who would be considered to be at high or intermediate risk for traditional valve replacement surgery. So, if you can’t replace the valve without significant risk, a better approach is to just scooch it over a bit and introduce a new, working valve.
Traditional valve replacement tends to involve open-heart surgery, and that’s a far cry from a minimally invasive procedure. When you have TAVR performed via the femoral artery in your groin, however, your chest bones stay right where they are, and the cardiologist only makes a small opening in the upper part of the thigh to insert the hollow tube (catheter). This approach as you can see is a great option for those who qualify for it.
You’re likely to only be down and out for a few days (average: three to five days) after TAVR. After consulting some top-notch Ivy League mathematicians, I can verify that this is A LOT (technical term) faster than the six to eight weeks you’d need to recover from open-heart surgery.
Of course, everybody’s body is different. Your heart may not be in the same shape as someone else’s, and the approach the surgeon takes might be slightly different. Still, three to five days is the average. But about those surgical options … The approach other than the groin access is called transapical approach, which involves making a small (seriously, it’s small) incision in your chest and enter through the tip of the left ventricle to get to the aortic valve.
Both types of TAVR are only an option for patients at high or intermediate risk for open-heart surgery, so not everyone qualifies. But if you do, it’s a great option that you should explore with your doctor. And as far as the patients at low risk are concerned, the trials are underway to determine if TAVR would be a good option for them as well. So, stay tuned!!