Having a Transcatheter Aortic Valve Replacement (TAVR)

Your doctor recommends that you have a transcatheter aortic heart valve replacement (TAVR). This is a surgery to replace a diseased aortic valve with a new tissue or biological valve. TAVR is done by putting a thin, flexible tube (catheter) through a blood vessel in your groin, or through a small cut (incision) under the collarbone. Sometimes this procedure needs an incision in between your ribs. The catheter is used to deliver an artificial valve to your heart. The TAVR is a minimally invasive procedure that is an alternative to open heart surgery.

Be sure to talk with your doctor about any questions or concerns you have before the procedure. The procedure often takes 2 to 3 hours. You'll likely remain in the hospital for 1 to 3 days. Here's what to expect before, during, and after the procedure.

Before your procedure, you will have a physical exam and tests. These tests include X-rays, CT scans, lung tests, and blood tests. You will have an echocardiogram to check your aortic valve. This is a test that uses an ultrasound. It makes sound waves to create images of your heart. You may also have a cardiac catheterization. This will tell your doctor more about your heart. It shows how blood is flowing through your arteries and about the pressures inside your heart and lungs.

Before the procedure you will also need to:

• Tell your doctor about all medicines you take. This includes over-the-counter medicines, vitamins, herbs, and other supplements. It also includes any blood thinners, such as warfarin or daily aspirin. You may need to stop taking some or all of them before your surgery.
• Tell your doctor if you're allergic to any medicines, have had a reaction to anesthesia, or have a bleeding disorder.
• Stop smoking. Ask your doctor how soon before surgery you need to quit.
• Follow any directions you are given for not eating or drinking before surgery.
• Shower with special soap before the surgery if advised.
• Follow all other instructions that you are given.

The TAVR procedure is less invasive than traditional aortic valve replacement surgery. The procedure is done in an operating room or a specially equipped catheterization lab.

• Medical staff will put an I.V. (intravenous) line in your arm or hand. This supplies fluids and medicine.
• To allow you to comfortably sleep during the surgery, you may be given general anesthesia. Or you may just be given medicine (sedation) to help you relax.
• Staff places an arterial line into the artery in your wrist to keep track of blood pressure and take blood samples.
• Staff might place a small probe into your throat. This is to do a transesophageal echocardiogram during the procedure. Some health centers may not need this. If they do, you will get general anesthesia.
• You will be given antibiotics before the procedure to protect you from infection. You will also get antibiotics after the procedure.
• The doctor will put a catheter in the femoral artery in the groin. If they are not able to put a catheter in the groin, they may place the catheter in an artery near the armpit or neck. They will guide the catheter through the artery and into your heart and to your aortic valve. The doctor will put other catheters, from the neck, wrist, or the other leg, in your heart to take measurements and X-ray pictures during the procedure.
• The doctor will put the new valve through the catheter to the heart on a collapsed balloon.
• When the balloon is in the right place in the aortic valve area, the doctor will inflate it. This puts the new valve in place.
• The doctor will take measurements and images to make sure your new valve works correctly. Then the catheters are removed.
• The catheter is removed and your incision is closed.

If your groin artery is too small, your doctor may put the catheter through an artery near your armpit or neck. Or they may put the catheter through a cut under the collarbone or between your ribs instead.

You'll be moved to a cardiac monitoring unit as you wake from the anesthesia. When you first wake up, you may feel groggy, thirsty, or cold. These feelings won't last long. You will likely have some I.V. lines and an arterial line in your body. These are to give you medicines and nutrition, and to measure your heart function. Medical staff members will carefully keep track of that function. Your condition often will be stable within the first 1 to 2 days.

Your recovery will depend on how invasive your procedure is for your valve replacement. You will likely need to stay in the hospital for 1 to 3 days. If you've had the surgery done through your ribs, you may spend more time in the hospital than if you had the surgery done through your groin, armpit, or wrist. You'll be encouraged to stand and walk, even if you feel tired. Walking helps your muscle strength, blood flow, and breathing. Your doctor will let you know when you can go home. Have a family member or friend drive you home.