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TAVR

TAVR: a nonsurgical, catheter-based replacement of the aortic valve. Image courtesy Medtronic.

Transcatheter aortic valve replacement (TAVR) is an advanced, minimally invasive procedure for patients with severe narrowing (stenosis) of the aortic valve. With this procedure, specialists can replace the aortic valve without having to resort to open-heart surgery and without having to remove the diseased valve.

TAVR is currently recommended only for individuals who are not considered well enough to undergo a surgical replacement of the aortic valve. TAVR allows patients who have severe narrowing of the aortic but who are too high-risk for open-heart surgery to receive a new valve. Lourdes was among the first heart centers in its area to offer this procedure, performing it since 2012. The other good news about TAVR: recent studies have shown that this is also an appropriate procedure for certain patients who are considered at intermediate risk for surgery. With this new FDA-approve category of patients eligible for the procedure, individuals who are younger and in better overall health than conventional TAVR candidates can benefit from the procedure.

The Lourdes team, including cross-trained operating-room and cardiac catheterization staff, perform the procedure in Lourdes’ purpose-built hybrid lab. This staff works collaboratively throughout each patient’s evaluation and care, making assessments and interventions as a multidisciplinary group. The team considers each patient’s case evaluating whether he or she is a candidate for surgery and whether open surgery or TAVR is the best choice.

TAVR is offering aortic valve replacement to many individuals who would not previously have had this option.

Using a catheter procedure, the TAVR team places the new valve within the patient’s diseased valve while the heart is beating. The new valve pushes the old valve aside and starts working immediately.

Hospitalization is usually just a few days. The TAVR nurse coordinator schedules and follows the patient throughout the course care.

Testing for TAVR

Severe aortic stenosis occurs when the heart valve send blood out of the heart and into the aorta does not open and close properly due to excessive calcium build-up. This makes it harder for the heart to pump blood through the body, limits a person’s normal daily activities and presents the eventual risk of heart failure. Candidates for TAVR, will undergo a series of tests, including:

  • confirmation of the severe aortic stenosis diagnosis by two cardiac surgeons
  • an echocardiogram of the heart to determine the size of the aortic valve
  • a multidetector computed tomography (CT) scan to get a closer look at the valve
  • a diagnostic cardiac catheterization to assess the condition of the coronary arteries.

At many hospitals, these tests can take several months to do. Lourdes can complete them and schedule the patient’s TAVR procedure in a few days to weeks.

Significantly Shorter Recovery, Compared to Surgery

See Lourdes’ physician newsletter on replacing the aortic valve without surgery (TAVR).

The Lourdes staff has successful multi-year experience with the TAVR, attracting and serving patients from throughout southern New Jersey and beyond for whom this procedure can be a god-send. Conducted in a hybrid lab, the procedure at Lourdes has the added safety, convenience and efficiency of quick conversion to open surgery, in the rare circumstances in which that might be necessary. In this way, the surgical team offers immediate back-up in the same room.

The team can monitor the progress of the procedure with chest ultrasound and/or transesophageal echocardiogram (TEE), a way of monitoring the heart with a small probe placed in the esophagus. In some cases general anesthesia is not necessary, but sedation is always used.

TAVR offers all the advantages of a nonsurgical procedure, when compared to an open-heart operation. Hospital stay, typically two to three days, and recovery are shorter.

The Lourdes team can also use TAVR to replace compromised or worn-out bioprosthetic valves in patients who have previously had such implants.

In addition, the respected and accomplished cardiothoracic surgery program at Lourdes offers minimally invasive open aortic valve replacement. Learm more.

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