Transcatheter Aortic Valve Replacement (TAVR) Procedure

Transcatheter aortic valve replacement (TAVR) is a minimally invasive, catheter-based procedure for people who have aortic stenosis, or stenosis or leaking of a bioprosthetic aortic valve.

The cardiovascular specialists at UPMC are among the region’s most experienced at performing TAVR. Although the TAVR procedure was once reserved for patients who were too sick for open-heart surgery, TAVR is now approved for many patients with aortic valve disease.

What Is TAVR?

TAVR is a minimally invasive procedure that treats aortic stenosis, or stenosis and/or leaking of a surgical bioprosthetic aortic valve.

In this surgery, the doctor replaces a defective aortic valve with a biological tissue valve from a cow or pig. This allows your heart to keep working normally.

TAVR has a faster recovery time than open-heart surgery, getting you back on your feet quicker.

Conditions we treat with TAVR

Doctors use TAVR to treat people with aortic valve disease, including:

• Aortic stenosis.
• Bioprosthetic aortic regurgitation.
• Rheumatic valve disease.

What are the benefits of TAVR?

• A minimally invasive procedure that surgeons perform while the heart beats.
• Can improve symptoms of heart failure such as shortness of breath or fatigue with exertion.
• Doesn't involve open-heart surgery or a heart-lung bypass machine.
• May aid in a faster recovery with a lower risk of complications.

Is TAVR the same as a stent?

Although both the TAVR and stent procedures can be performed using catheters, they are different procedures with different purposes. TAVR is a procedure to replace your aortic valve. A stent is a small tube placed during a stenting procedure to hold open a weak or narrowed blood vessel.

Why Would I Need TAVR?

Your care team may recommend TAVR for you based on:

• Condition of your arteries.
• Your age.
• Your current symptoms.
• Your life expectancy.
• Your medical history.

Because the catheter enters your heart through an artery, typically in the groin, your arteries must be healthy.

Pre-op testing will help your care team determine your fitness for the procedure and make sure you're healthy enough for surgery.

Who’s a candidate for TAVR?

Although the TAVR procedure was once reserved for people who were too sick for traditional open-heart surgery for heart-valve replacement, UPMC now offers TAVR to:

• High-surgical-risk patients — UPMC experts were among the authors of the published landmark study, which favorably compared TAVR to surgical aortic valve replacement in patients with severe aortic stenosis who are at increased surgical risk.
• Moderate-surgical-risk patients — Through the Medtronic CoreValve® SURTAVI trial, UPMC in Central Pa. was the first hospital, and top national enroller in the United States, to deploy this type of valve for people at moderate surgical risk.
• Low-surgical-risk patients — UPMC experts were leaders in a low-risk clinical trial. Further, UPMC experts authored a journal article in the New England Journal of Medicine about TAVR for low-risk patients.

Alternatives to TAVR

• Aortic valve repair.
• Aortic valve balloon valvuloplasty.
• Medical management.
• Open aortic valve replacement.

What Are the Risks and Complications of TAVR?

Many people with severe aortic stenosis are at increased risk of complications from open-heart surgery. While it may not be right for everyone, TAVR may provide another treatment option.

What are the downsides of TAVR?

TAVR is a surgical technique that involves sedation. It carries a low risk of complications but, as with any surgery, there are some risks, including:

• Damage to the artery used for insertion of the valve.
• Major bleeding.
• Need for a pacemaker.
• Stroke.
• Other serious life-threatening events or even death.

What Should I Expect From TAVR?

If your doctor recommends TAVR, our team of heart valve experts will start by doing a thorough exam. During your TAVR exam, you'll meet with:

• Advanced practice providers.
• A heart surgeon.
• An interventional cardiologist.

If we decide TAVR is right for you, this is what you can expect during the procedure:

• A small incision or puncture in the groin, chest, or neck to place the transcatheter valve. Sedation is often used instead of general anesthesia.
• A shorter time in the operating room or catheterization lab.
• Most patients return home the day after their TAVR procedure and are cleared to resume normal activities in 1 to 2 weeks.

_{Transcatheter aortic valve replacement is a less invasive approach for replacing a diseased aortic valve. This is performed through catheters placed in blood vessels in the groin, chest, or neck.} 

Our experts use the latest diagnostic tests to learn about your heart valve condition, including:

• Cardiac catheterization — This diagnostic procedure involves inserting a tiny, hollow tube (catheter) through a large artery in your leg or arm leading to your heart to provide images of your heart and blood vessels. This procedure is helpful in determining the type and extent of certain valve disorders.
• Chest x-ray — A chest x-ray is a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. An x-ray can show enlargement in any area of the heart.
• CT angiogram — A CT angiogram is an imaging test that looks at the arteries that supply your heart muscle. This test uses a powerful x-ray machine to produce images of your heart and heart vessels.
• Echocardiogram (Echo) — This noninvasive ultrasound test uses sound waves to evaluate your heart’s chambers and valves. The echo sound waves create an image on a monitor as an ultrasound transducer is passed over your heart.
• Electrocardiogram (ECG or EKG) — This test records the electrical activity of your heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and can sometimes detect heart muscle damage.
• Magnetic resonance imaging (MRI) — is a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body.
• Transesophageal echocardiogram (TEE) — TEE is a form of echocardiography that is performed by inserting a probe with a transducer into your esophagus rather than placing the transducer on your chest as in a traditional echocardiogram. A TEE provides a clearer image of your heart because the sound waves do not have to pass through skin, muscle, or bone.
• Two-dimensional echocardiogram (2D Echo) — This test uses ultrasound to display a cross-sectional “slice” of your beating heart, including the chambers, valves, and the major blood vessels that exit from the left and right part of your heart.

Your doctor may also order other tests, such as:

• Bloodwork.
• An exercise stress test.
• Lung function tests.
• Ultrasound of your carotid artery.

Before: How to prepare for TAVR

Your doctor will explain the TAVR procedure to you and give you a chance to ask questions. To prepare for TAVR, you should:

• Tell your doctor if you are sensitive or allergic to any medications, iodine, latex, tape, or anesthetic agents (local and general).
• Tell your doctor about all medications (prescription and over-the-counter) and herbal or other supplements you are taking.
• Tell your doctor if you have a history of bleeding disorders or if you are taking any blood-thinning medications, aspirin, or other medications that affect blood clotting. It may be necessary to stop some of the medications prior to the procedure.
• Fast for a certain time before the procedure. Your doctor will tell you how long to fast (usually overnight).
• Have any tests that your doctor recommends. For example, your doctor may request a blood test prior to the procedure to determine how long it takes your blood to clot.

On the day of your TAVR procedure, be sure to bring your photo ID and health insurance card(s). Leave valuables such as cash and jewelry at home.

After your TAVR procedure, you will stay in the hospital overnight. You should bring toiletries, a robe, slippers, a cell phone and charger, medications, and a change of clothes. You should also arrange for someone to drive you home from the hospital after you are discharged.

How long does TAVR take?

Your TAVR procedure will take about one hour. After your procedure is complete, you will spend 1-2 hours in the recovery room before being transferred to your hospital room.

During your TAVR

On the day of your TAVR, before your surgery, you should expect to:

• Arrive at the hospital about two hours before.
• Meet with the heart valve team and anesthesiologist.
• Complete ECG and bloodwork.

During a TAVR procedure, your surgeon and cardiologist:

• Access an artery in your groin, neck, or side of your chest and insert a catheter.
• Use a special moving x-ray — called fluoroscopy — to guide the new valve to your heart and into the aortic valve.
• Open the new valve. The new valve expands within your existing one and restores proper blood flow. 

Your malfunctioning valve will be replaced with a new one, leaving you with a smoothly operating valve that delivers better blood flow from your heart to the rest of your body. Your new valve will be made of either cow or pig tissue that has been reinforced with a stainless-steel stent.

Recovery after TAVR

When your TAVR procedure is completed, you will be moved to recovery for observation and monitoring. Most people return home from the hospital the day after their TAVR procedure.

When you go home, you’ll need help from a family member or caregiver for the first few days. Your heart valve team will let you know when you can resume your normal activities after you are discharged from the hospital.

When compared to traditional open-chest surgery, patients who have a TAVR procedure typically experience less pain, have a shorter hospital stay, and recover more quickly. However, you should follow your doctor’s instructions and go to all your follow-up appointments.

You'll have follow-up exams and tests in the days and months after TAVR, including:

• An echocardiogram the day after.
• Outpatient bloodwork as ordered by your doctor.
• A valve center visit and echocardiogram about a month after.
• A follow-up visit and echocardiogram one year after TAVR.

When to call your doctor about TAVR complications

You should call your doctor if you are experiencing any unusual symptoms, including:

• A fever of more than 100.0°F.
• Burning or pain in your chest.
• Difficulty swallowing, throat pain, or bloody cough.
• Lightheadedness.
• New or increasing shortness of breath or difficulty breathing.
• Pain, redness, bleeding, drainage, or increased swelling at the insertion site.
• Rapid or pounding heartbeat.
• Redness or rash on your chest or back.
• Severe pain, coldness, numbness, or discoloration in the limb where the catheter was inserted.
• Weight gain or swelling in your abdomen or legs.

Call 911 if you pass out or experience stroke-like symptoms such as facial droop, arm or leg weakness, or speech difficulty.

What’s the prognosis after TAVR?

Most people can live active and full lives after their TAVR procedure. Your doctor will discuss your prognosis with you.

What is the life expectancy after TAVR?

For most people, life expectancy after TAVR is the same as anyone else who does not have heart problems. Talk to your doctor if you have questions about your life expectancy after your TAVR procedure.

What’s the success rate of TAVR?

UPMC is in the top 1 percent of hospitals in the U.S. for the number of TAVRs we perform, making us one of the top hospitals doing the procedure. Our outcomes are among the best in the nation, and as we do more TAVR procedures, our success rates continue to improve.

Why Choose UPMC for TAVR?

Since 2011, the specialists at UPMC have been performing the minimally invasive TAVR procedure with outstanding results. UPMC has access to transcatheter valves made by Abbott, Medtronic, and Edwards, offering patients transcatheter valves that are best suited for their anatomy.

We are a high-volume center experienced at performing TAVRs for patients who are low-risk and patients with complex medical histories and challenging anatomies.

Our heart valve experts participate in clinical research trials and have published many articles in leading journals about TAVR and its outcomes. Please contact us to see if you may be a candidate for a TAVR clinical trial or to learn about our current clinical trials.

Medically reviewed by: Elizabeth Christensen, CRNP on 2024-10-01.