Frequently asked questions about severe aortic stenosis and TAVR
I’ve heard both TAVR and TAVI, what’s the difference?
Transcatheter Heart Valve Replacement (TAVR) and Transcatheter Heart Valve Implantation (TAVI) are two different names for the exact same procedure.
Is the TAVR procedure safe?
Clinical trials have demonstrated that TAVR is safe and effective. Of course, there are risks associated with all medical procedures. Be sure to talk with your doctor so that you thoroughly understand all the risks associated with transcatheter aortic valve replacement.
Some of the risks include:
- Pacemakers: When valves are placed, they can sometimes interfere with the heart’s electrical system and create a need for either a temporary or permanent pacemaker.
- Kidney damage or failure: The contrast dye used for imaging can hurt your kidneys, though the problem is usually reversible.
- Stroke or other neurological impairment: A small percentage of people undergoing a TAVR procedure have a stroke, either during the procedure or in the days immediately following it.
- Death: While TAVR is an effective and often much-needed treatment for people with severe aortic stenosis, they face a very low possibility of not surviving the procedure.
What is the success rate for TAVR?
Aortic stenosis is the most common valvular heart disease in the world, affecting approximately 7 percent of the population over age 65.1 From the onset of severe aortic stenosis symptoms, the average survival rate is 50 percent at two years and 20 percent at five years without aortic valve replacement.2,3
Why can’t I just take medications to fix my severe aortic stenosis?
When you have severe aortic stenosis, you have calcium buildup on your heart’s aortic valve, which makes it unable to open and close properly. Medication alone cannot stop or cure the disease, it can only treat the symptoms. Replacing the aortic valve is the only effective treatment for stenosis. Without the benefit of a replacement valve, up to 50% of people who develop severe aortic stenosis symptoms will die within an average of two years.2,3
Can I ask for a specific heart valve?
Yes you can ask about a specific TAVR valve. Your Heart Team will help you understand all the benefits and risks, advantages and disadvantages of each type of aortic valve replacement, while taking into consideration your age, health, and a variety of other factors.
What does “minimally-invasive” mean?
TAVR is described as minimally-invasive because the procedure is completed without opening your chest to reach the heart. Instead, the heart is accessed through a small incision in your artery or blood vessel, most often in the groin. Your doctor will insert a small, hollow tube, called a catheter, and use it to send the replacement valve to the heart. As a result, you’re likely to experience a faster recovery time and less discomfort.
Who will I be seeing / Who is on my care team?
Your heart team will include cardiologists, cardiac surgeons, imaging specialists and a registered nurse. Working together, this group will select the appropriate replacement procedure and device, as well as plan and perform your procedure.
Why can’t everyone have TAVR?
Replacing the aortic valve is the only effective treatment for severe aortic stenosis. Being a candidate for TAVR requires your condition to meet specific medical criteria. Your heart team will conduct several tests and procedures — such as a chest X-ray, echocardiogram, and angiogram — to determine if TAVR is the right treatment for you.
Why can’t I get my valve replaced right away when diagnosed with aortic stenosis?
Aortic stenosis is a progressive disease that typically, but not always, worsen over time. Your cardiologist will conduct various tests, such as a, echocardiogram or angiogram, to monitor your condition. Once your aortic stenosis symptoms become more significant, your doctors will need time to conduct additional tests to decide what the best valve replacement procedure is for you.
Will I be awake during the TAVR procedure?
Your care team will determine what type of anesthesia is best for you. You may be fully asleep, or you may be awake but given medication to help you relax and manage any pain.
How long will the TAVR procedure take?
A typical TAVR procedure lasts approximately 1.5 hours. In comparison, the average open-heart surgery lasts approximately 4 hours. The exact time will depend on your health and the procedural approach recommended by your heart team.
What is left behind in the TAVR procedure?
The only thing left in your heart is the new valve.
How often should I see my doctor?
Successful recovery requires keeping scheduled visits with your doctor. You can expect to visit your doctor 30 days after your TAVR procedure and then again one year after your procedure. Do not wait for an appointment if you experience discomfort, or changes in your health.
How will I know if my heart valve is working properly?
Your TAVR procedure will restore the normal flow of blood immediately. At a follow-up care appointment, your doctor will check how well your heart is working, your healing, and your overall health.
Call 911 immediately if you experience:
- Chest pain or trouble breathing
- Sudden numbness or weakness in your face, arms or legs
- A bowel movement that is dark black or bright red
- Dizziness or fainting
- Increased swelling in your hands, feet or ankles
- Shortness of breath that doesn’t get better by resting
Can the replacement aortic valve crush, bend, or move out of place?
Deformation or movement is possible but rare.
Will I feel the replacement valve?
Once the device is in place and the access site is healed, you will not feel the device. If you feel anything abnormal, please contact your heart team.
Will the replacement valve cause problems with metal detectors or interfere with future X-ray procedures?
The device will not hamper the ability to perform future medical imaging procedures such as MRI scans, X-rays, and CT scans. However, you should always notify your doctor that you have an artificial valve beforehand.
What medications will I need to remain on after the procedure?
Depending upon the type of replacement valve you have, your heart team will let you know what, if any, medications are required.
How long will the replacement valve last?
Historically, biologic valves usually needed to be re-replaced after around 10 years. Mechanical valves are designed to work just like your natural valve and are made of carbon or metal. They are made to last a lifetime and considered very durable.
What kind of restrictions will I have after valve replacement?
For the first couple days after your procedure, you may need to stay at the hospital. Be sure to talk to your heart team about any specific diet, exercise, or other activity restrictions.
Can I travel after I have my valve replaced?
There are generally no restrictions after your heart valve replacement. Be sure to ask your doctor if you have questions.
1. Bach D, Radeva J, Birnbaum H, et al. Prevalence, Referral Patterns, Testing, and Surgery in Aortic Valve Disease: Leaving Women and Elderly Patients Behind. J Heart Valve Disease. 2007:362-9.
2. Iivanainen A, Lindroos M, Tilvis R, et al. Natural History of Aortic Valve Stenosis of Varying Severity in the Elderly. Am J Cardiol. 1996:97-101.
3. Aronow W, Ahn C, Kronzon I. Comparison of Echocardiographic Abnormalities in African-American, Hispanic, and White Men and Women Aged >60 Years. Am J Cardiol. 2001:1131-3.