TAVR once was available only for the sickest aortic stenosis patients, but the minimally invasive procedure is now more often an alternative to open heart surgery.

Published: November 29, 2019 | Updated: October 13, 2020

The minimally invasive transcatheter aortic valve replacement (TAVR) procedure — once thought appropriate only for the sickest aortic stenosis patients — increasingly is being used as an alternative to open heart surgery valve replacement.

TAVR is an option now for nearly all patients.

“With TAVR, we’re able to place the new valve by entering through an artery, much like we would a stent,” said D. Sean Stewart, M.D., interventional cardiologist with Norton Heart & Vascular Institute. “Patients eligible for this minimally invasive approach often go home after an overnight stay.”

TAVR is now an option even for patients for whom open heart surgery for valve replacement would be low risk. The procedure was at first only for those who faced high risk if they underwent open heart surgery, then expanded to include those with intermediate risk.

Open heart surgery is still preferred for younger patients, those with congenitally malformed valves and other specific cases.

Aortic stenosis means the valves have narrowed, become calcified and rigid. One in 2 patients with untreated symptoms of severe aortic stenosis will die within an average of two years.

TAVR vs. Open Heart Surgery

TAVR: Interventional cardiologists access the damaged valve through an artery — usually in the groin. The new valve is collapsed and placed on the end of a catheter or tube that is threaded through the blood vessels to the aortic valve.

There, the new valve is expanded and pushes the leaflets of the damaged valve aside to take over regulation of blood flow. The TAVR valve leaflets open and close with each heartbeat, just like the person’s heart valve did when it was healthy.

After more than a decade of data, the durability of the valves used in TAVR compares favorably with surgically implanted valves, Dr. Stewart said.

Avoiding open heart surgery means there are fewer risks, and patients typically recover much faster and with a shorter hospital stay.

Open heart surgery: Surgical aortic valve replacement involves an incision in the chest to provide access to the heart. The surgeon stops the heart and turns over circulation to a heart-lung bypass machine.

The damaged valve is removed entirely and replaced with a new one.

The procedure has been performed for more than 50 years. Patients should be healthy enough that they have a very strong ability to withstand the trauma of open heart surgery.

After surgical aortic valve replacement, patients usually stay in the hospital about a week, with at least a few days in intensive care.

The Heart Valves’ Functions

The valves make sure blood keeps moving in the right direction. Between heartbeats the aortic, pulmonic, mitral and tricuspid valves close to prevent blood from flowing backward. If a valve isn’t working right, your heart needs to work harder to keep the blood moving in the right direction.

The interventional cardiologists at Norton Heart & Vascular Institute use two kinds of aortic replacement valves for TAVR: the Edwards Sapien valve and the Medtronic CoreValve. The Edwards Sapien valve is made from cow heart tissue and is supported by a cobalt and chromium frame. The Medtronic CoreValve is made from pig heart tissue and has a frame made from a flexible nickel-titanium alloy.