Having a Transcatheter Aortic Valve Replacement (TAVR)
Your health care provider recommends that you have a transcatheter aortic heart valve replacement (TAVR). This is a surgery to replace a diseased aortic valve with a new valve. TAVR is done by putting a thin, flexible tube called a catheter through a blood vessel in your groin or sometimes through a small incision between your ribs. The catheter is used to deliver an artificial valve to your heart. The TAVR procedure has been recommended to you as an alternative to open heart surgery.
Be sure to talk with your health care provider about any questions or concerns you have before the surgery. The surgery takes 3 to 5 hours. You’ll remain in the hospital for 4 to 8 days. Here’s what to expect before, during, and after the procedure.
Before the procedure
Before the day of surgery, you will have a complete medical evaluation, including a physical exam. You will also have tests. These tests may 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 sound waves to create images of your heart. You may also have a cardiac catheterization. This will tell your doctor more about your heart and how blood is flowing through your arteries.
Before the surgery you will also need to:
Tell your health care provider about all medications you take. This includes over-the-counter medications, 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 health care provider if you’re allergic to any medications or have a bleeding disorder.
Stop smoking. Ask your health care provider how soon before surgery you need to quit.
Not eat or drink for a certain number of hours before the surgery. Your doctor will give you specific instructions.
Shower with special soap before the surgery if advised.
Follow all other instructions that you are given.
During the procedure
Even though the TAVR procedure uses a less invasive approach than traditional aortic valve replacement surgery, the procedure is generally carried out with general anesthesia in an operating room or specially equipped catheterization lab. An intravenous (IV) line is put in your arm or hand. This supplies fluids and medication. To keep you free of pain during the surgery, you are given general anesthesia. This medication puts you in a state like deep sleep through the procedure. A catheter is placed into your bladder to drain urine. A small probe is placed into your throat. This is to do echocardiograms during the procedure. Then:
A catheter is put in the femoral artery in the groin. It is then guided through the artery up into your heart and to your aortic valve. Other catheters, from the neck, wrist, or the other leg, are put in your heart to take measurements and X-ray pictures during the procedure.
The new valve is delivered through the catheter to the heart on a collapsed balloon.
When the balloon is in the right place in the aortic valve area, it is inflated. This puts the new valve in place.
Measurements and images are taken to make sure your new valve works properly. Then the catheters are removed.
The catheter in your leg is removed and your incision is closed.
Your doctor may decide to put the catheter and new valve through a cut between your ribs instead of into your groin. He or she will guide the catheter into the bottom of your heart to your aortic valve. You may need this approach if the artery in your groin is too small or if it contains too much plaque to allow clear passage of the valve from the leg approach.
After the procedure
You’ll be moved to the intensive care unit (ICU) to start your recovery. When you first wake up, you may feel groggy, thirsty, or cold. These feelings won’t last long. You will likely have some thin tubes in your body. These are to give you medications, nutrition, and measure your heart function. If you had the surgery done through your ribs, you may also have a tube coming out of your chest. The tubes will be removed when they are no longer needed. Medical staff members will carefully watch you. er the procedure, but it is generally removed as soon as you are able to wake up. You may have a brething tube in your throat aftWhen your condition is stable, you’ll be taken to your hospital room.
You will likely need to stay in the hospital for several days. You may even need to stay longer than a week. 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. After you leave the ICU, you will go to a general cardiology area of the hospital to recover further. You’ll be encouraged to stand and walk, even if you feel tired. Walking helps your muscle strength, blood flow, and breathing. Your health care provider will let you know when you can go home. Have a family member or friend drive you home.