Transcatheter aortic valve replacement (TAVR)

The aortic valve controls blood flow between the lower left heart chamber (ventricle) and the aorta, the main artery that pumps blood through the body. A narrowed aortic valve can restrict blood flow to the body.

TAVR is a minimally invasive structural heart disease treatment. In TAVR (also called transcatheter aortic valve implantation (TAVI) or a valve-in-valve procedure), your doctor places a new aortic valve inside the damaged one. The new valve pushes the old valve out of the way and immediately starts working to control blood flow.

A transcatheter aortic valve replacement may be appropriate for people with:

• Aortic valve narrowing (aortic valve stenosis)
• Bicuspid aortic valve (BAV), along with aortic stenosis
• A prior valve replacement that is wearing out

TAVR is an option for most patients over age 65 with aortic stenosis, including those who aren’t candidates for open-chest aortic valve repair and replacement surgery. Older patients and those with underlying health conditions have higher risks of open-chest surgeries and are often better candidates for the TAVR procedure.

A transcatheter aortic valve replacement may be appropriate for people with:

• Aortic valve narrowing (aortic valve stenosis)
• Bicuspid aortic valve (BAV), along with aortic stenosis
• A prior valve replacement that is wearing out

TAVR is an option for most patients over age 65 with aortic stenosis, including those who aren’t candidates for open-chest aortic valve repair and replacement surgery. Older patients and those with underlying health conditions have higher risks of open-chest surgeries and are often better candidates for the TAVR procedure.

Your care team will give you specific instructions on how to prepare for TAVR. Tell your provider about any medications you take regularly. You may need to stop taking certain medications, such as blood thinners, for a brief period before the procedure.

Your treatment team will tell you what you need to bring to the hospital, including:

• A medication list, including all over-the-counter medicines and supplements you take regularly
• Comfortable, loose clothing
• Hearing aids, eyeglasses, or dentures, if applicable
• Toiletries such as a toothbrush, comb, or razor

The care team will also instruct you on what not to wear. For example, you’ll need to remove contact lenses or eyeglasses and avoid wearing any jewelry on the day of the procedure.

TAVR is an inpatient procedure lasting up to two hours. You receive anesthesia to keep you comfortable and calm. The team includes an interventional cardiologist, cardiac surgeon, an interventional echocardiographer and an anesthesia specialist.

During the TAVR procedure, your doctor:

1. Makes a tiny incision in your groin and inserts a flexible, hollow tube (catheter) into a blood vessel
2. Uses imaging guidance to thread the catheter to your aortic valve
3. Sends a compressed heart valve through the catheter
4. Positions the new valve inside your damaged aortic valve
5. Expands the new valve to secure it in place

A filter called an embolic protection device may also be placed in the blood vessels leading from your heart to your brain. These devices catch a fatty substance called plaque or other debris to prevent it from traveling to your brain and causing a stroke.

At Penn Medicine, we use embolic protection during most TAVR procedures and participate in ongoing clinical trials to test new embolic protection devices.

Most people experience rapid relief from aortic stenosis symptoms after TAVR. Because the TAVR procedure only uses a tiny incision and does not require open-chest surgery, people also experience less pain and a quicker recovery, including less time in the hospital.

Although TAVR complications are rare, all medical procedures come with some risks. Risks associated with the TAVR procedure may include:

• Arrhythmias (irregular heart rhythms)
• Bleeding
• Damage to the blood vessels
• Heart attack or stroke
• Infection
• Problems with the replacement valve, such as leaking or moving out of place

Your care team monitors you regularly after TAVR to look for signs of complications.

Penn interventional cardiologists and cardiac surgeons were among the first in the nation to offer the TAVR procedure starting in 2007. Since then, our continual clinical trial involvement has allowed us to offer the most leading-edge valve replacement therapies, often before they’re widely available.

When you choose our team, you benefit from:

• Deep experience: We perform nearly 600 TAVR procedures each year, placing us among the top five centers in the country in TAVR volumes. Our high volumes position our physicians as some of the most experienced in the nation.
• Highly ranked care: The Transcatheter Valve Therapy (TVT) Registry, a national registry with the Society of Thoracic Surgeons and the American College of Cardiology, has designated us with their highest ratings for TAVR outcomes. We are the only medical system in the Philadelphia region with the highest possible TVT Registry TAVR rating.
• Excellent outcomes: Our TAVR outcomes meet and even exceed national averages. Our use of embolic protection in nearly all our TAVR patients results in reduced stroke risk and better outcomes for our patients.

Penn interventional cardiologists and cardiac surgeons were among the first in the nation to offer the TAVR procedure starting in 2007. Since then, our continual clinical trial involvement has allowed us to offer the most leading-edge valve replacement therapies, often before they’re widely available.

When you choose our team, you benefit from:

• Deep experience: We perform nearly 600 TAVR procedures each year, placing us among the top five centers in the country in TAVR volumes. Our high volumes position our physicians as some of the most experienced in the nation.
• Highly ranked care: The Transcatheter Valve Therapy (TVT) Registry, a national registry with the Society of Thoracic Surgeons and the American College of Cardiology, has designated us with their highest ratings for TAVR outcomes. We are the only medical system in the Philadelphia region with the highest possible TVT Registry TAVR rating.
• Excellent outcomes: Our TAVR outcomes meet and even exceed national averages. Our use of embolic protection in nearly all our TAVR patients results in reduced stroke risk and better outcomes for our patients.