A Less Invasive Alternative to Open-Heart Surgery: TAVR

surgeons at work

Aortic stenosis (AS), a narrowing of the heart valve that reduces or cuts off blood flow from the heart to the rest of the body, is one of the most common and serious heart valve problems.

Symptoms may include chest discomfort, passing out, and swelling in the legs. While this condition can be caused by a congenital heart defect, it most often develops due to calcium buildup or scarring damage in the valve over time. In fact, most patients start to develop AS around age 60 but don't show symptoms until they're 70 to 80. Severe AS is often treated as soon as possible because of the risks it carries; it can lead to congestive heart failure, blood clots, and other problems. If left untreated, the three-year survival rate is under 30 percent.

Since the 1950s, the go-to treatment for aortic stenosis has been open-heart surgery. This serious operation involves making an incision in the chest and splitting open the rib cage to operate on the heart. General anesthesia is required, and side effects can range from heart attack or stroke to lung or kidney failure to blood clots. After the surgery, most people spend about a week in the hospital, and recovery is gradual - it generally takes about six weeks for patients to start feeling better, and it can be up to six months after the surgery until they feel truly like themselves again.

Open heart surgery is a serious undertaking - and it's not an option for everyone. About one-third of patients 75 and over with severe AS are declined for open-heart surgery.

Fortunately, in 2011, the Food and Drug Administration approved a procedure called transcatheter aortic valve replacement (TAVR) for patients with symptomatic AS for whom open-heart surgery would be too dangerous due to other medical conditions, age, or both.

The TAVR procedure is a lot less involved than open-heart surgery. This two- to three-hour surgery can sometimes be performed while you're sedated rather than under general anesthesia (your care team will make this call), and it requires only a small incision in your leg artery (near your groin), or in your chest. The surgeon then guides a sheath through the blood vessel, and threads a catheter with a new biological valve through it and into your heart. (Open-heart surgery involves removing the old valve, whereas TAVR simply repairs it using a replacement.) Once the valve is in position and tested to be sure it is working properly, the catheter is removed and the incision is closed.

Once the minimally invasive surgery is complete, patients feel better fairly quickly. Most people are up and walking within 24 hours, and leave the hospital after a few days. It takes several weeks for patients to return to their normal routines - sometimes four to six weeks - but sometimes even less time.

If you undergo a TAVR procedure, your care team will provide guidance on diet, exercise, and lifestyle modifications to make following your surgery. Blood-thinning medications may be prescribed for a short period after the procedure. You'll need to return for regular checkups to make sure your new valve is functioning the way it should and identify any problems as early as possible.

Of course, with any procedure, there are risks, such as stroke, blood vessel complications, and bleeding - but likelihood of those risks with TAVR is much lower than with open-heart surgery.

If you have aortic stenosis, talk with your primary care physician or cardiac specialist about TAVR and see if it could be an option for you. Find out more about the procedure on MAPMG's Staying Healthy pages.

Mid-Atlantic Permanente Medical Group, P.C. (Permanente) is our network of over 1,500 physicians who practice in our medical centers located in Maryland, the District of Columbia, and Virginia.

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