TAVR: Transcatheter Aortic Valve Replacement

What is TAVR?

TAVR stands for Transcatheter Aortic Valve Replacement, a minimally invasive, catheter-based procedure to replace the diseased aortic valve in patients with severe aortic stenosis. Aortic stenosis is a condition in which the aortic valve does not open fully due to a thickening of the valve leaflets, often caused by a buildup of calcium on the leaflets. This thickening makes it difficult for the leaflets to open and close, which decreases blood flow from the heart to the body. The condition may cause the heart to work harder to pump blood.

For decades, open heart surgical aortic valve replacement (SAVR) has been the standard treatment for severe aortic stenosis, but in the past few years TAVR has rapidly replaced SAVR in high-risk patients as well as patients at moderate risk for surgery. This is due to excellent clinical trial results showing equal or better patient outcomes compared to SAVR.

TAVR Approved for Low-Risk Patients

Most recently, in August of 2019, TAVR was approved for patients at low risk for surgery. These low-risk patients, whose aortic stenosis would typically receive an open-heart surgical aortic valve replacement, can now be considered a candidate for a TAVR procedure.

To learn more about TAVR, visit our Frequently Asked Questions: TAVR page.

What is Involved in a TAVR Procedure?

Unlike SAVR, which involves surgically opening the chest to replace a patient’s aortic valve, the minimally invasive TAVR can be done through very small incisions.

The TAVR procedure uses a catheter to insert the new valve. This can be performed in a few ways, depending on the surgeon’s recommendation. These include:

  • Transfemoral approach: The surgeon enters via a needle puncture through a large artery in the groin (femoral artery).
  • Transapical approach: The surgeon makes a small incision in the chest between the ribs and enters through a large artery in the chest or through the tip of the left ventricle (apex).
  • Transaortic approach: The surgeon makes a small incision in the upper chest.

Patients who undergo a minimally invasive TAVR procedure experience less down time, faster recovery and, often, a shorter hospital stay (3-5 days on average) than patients undergoing open heart surgery. Most patients begin the process of gaining their strength back and start cardiac rehabilitation within a period of days or weeks, which results in dramatic improvements in their quality of life. In contrast, open heart surgical procedures often require a total recovery time of up to three months.

Valve-in-Valve TAVR Procedure

TAVR technology is also being used to restore the function of failing bioprosthetic (or tissue) valves and may be the best valve-replacement option for high-risk patients. Over time (approximately 10 to 15 years), the bioprosthetic valve degenerates and eventually fails, requiring the need for replacement. The TAVR option is often chosen because it offers a minimally invasive procedure to patients who previously underwent open heart surgery for a bioprosthetic valve. Learn more about the valve-in-valve TAVR procedure.

To learn more about TAVR, visit our Frequently Asked Questions:TAVR page.

TAVR at the University of Michigan

The U-M Frankel Cardiovascular Center has extensive experience in TAVR and is one of the only health systems in the region to offer the full spectrum of available valve options. With over 1,500 TAVRs having been performed to date, U-M leads the state in the number of these procedures and is one of the top programs in the country. Our interdisciplinary TAVR team represents a strong partnership between cardiac surgery and interventional cardiology, offering patients the highest level of expertise and care. In addition, Michigan Medicine was one of only three health systems in Michigan invited to participate in the clinical trial offering TAVR for patients who were low-risk surgical candidates, and the excellent clinical trial results led to the approval of TAVR for these patients in August of 2019.

Learn more about the history of TAVR on our History of TAVR at the University of Michigan page.

Nurse Practitioners Provide Individualized Care for TAVR Patients

Our nurse practitioners (NPs) and nurse clinical care coordinator provide the first point of contact for patients with aortic stenosis who are referred to the transcatheter aortic valve replacement (TAVR) program. The NPs help evaluate patients and work with the TAVR program physicians to create an individualized plan of care. The evaluation for TAVR can be complex, and depending on patient anatomy, risk level and other factors, there might be several available options, which often raises many questions for patients and their families. The TAVR NPs are there to answer questions and help patients and families be an active part of their care team throughout the entire TAVR process from the initial evaluation through recovery period.

Patient Resources

 

Click on our TAVR video playlist (in the right corner of the video above) for more information about TAVR at the University of Michigan.

Make an Appointment

To make an appointment to discuss whether you are a candidate for a heart valve replacement, call the University of Michigan Cardiovascular Call Center at 888-287-1082 or visit our Make a Cardiovascular Appointment page, where you can learn what to expect when you call us.