Heart Valve Replacement Then and Now with TAVR

Less than a decade ago, if you had severe narrowing of the aortic valve opening in your heart (aortic valve stenosis) or a severe leak in the aortic valve (aortic regurgitation) standard treatment would be open heart surgery to replace the malfunctioning valve. Fortunately, in 2011, the United States Food and Drug Administration (FDA) approved TAVR as a minimally invasive way to replace the aortic valve. This became a game changer, particularly for those who were not good candidates for traditional open heart surgery.

About Your Aortic Valve

Your heart has four valves: tricuspid, pulmonary, mitral and aortic. Each opens and closes to control the flow of blood in the body. The aortic valve is located in the lower left chamber (or ventricle) of the heart. To work properly, valves must be flexible to open and close completely. 

Some diseases affect the ability of the valves to operate properly. Aortic valve stenosis is one of the most common—and most serious valve diseases. It occurs when the aortic valve opening narrows, making it difficult for blood to pass through. Aortic valve stenosis may result from a congenital heart defect, but more often results with aging, as calcium and scarring damages the valve. As the disease progresses, the left ventricle can thicken in the heart, allowing less room for blood to flow through to the body, leading to heart failure.

A properly functioning aortic valve prevents blood from flowing back into the left ventricle, but with aortic regurgitation, the valve doesn’t close completely, allowing blood to leak back. That makes the heart work harder and can affect the health of the heart muscle and the structure of the ventricle walls. Aortic regurgitation can result from aging, high blood pressure, injury or a bacterial infection of the heart tissue. 

Treatment for Aortic Valve Problems

For aortic stenosis, your doctor may first examine your heart using an echocardiogram. For mild cases, the doctor may monitor your condition, but for more severe cases, heart valve replacement is necessary. For mild cases of aortic regurgitation, medications that thin the blood to reduce clotting may be effective, but as with aortic stenosis, if your condition is severe, surgery may be necessary to replace the valve.

Traditional Open Heart Surgery vs. TAVR

To understand just how transformative TAVR is, let’s compare the traditional open heart surgery with the newer, leading-edge technology.

Before TAVR, to replace a valve, you would undergo open heart surgery, which required the chest to be surgically opened, the valve to be removed and a new valve sewn in place. During the procedure, your heart would need to stop, so your surgeon would place you on a heart-lung bypass machine during the operation.

In comparison, TAVR is minimally invasive, and most procedures are done “incisionless” through a small puncture in the femoral artery in the leg. Your surgeon would guide a catheter with the new valve through that artery to your heart to replace the diseased valve. The new valve works immediately, and there would be no need to stop the heart or place you on a bypass machine. Other patient benefits include:

• Unlike open heart surgery, TAVR surgery may only require local anesthesia for the procedure.
• The TAVR procedure lasts about an hour, while traditional open heart surgery takes four to six hours.
• Patients who have TAVR have fewer risks for complications than those who undergo open heart surgery, including a lower stroke rate and less chance for major bleeding and atrial arrhythmias.

TAVR is particularly helpful for patients who may not tolerate an open heart procedure due to age, frailty, poor lung function or history of a previous surgery. As of 2016, TAVR has been performed on 300,000 patients around the world, with adoption of the technology increasing 40 percent each year, and has saved thousands of lives of people who were not good candidates for open heart replacement. As the success of the TAVR procedure continues to grow, doctors hope that more people, even if they are at a low risk for complications, will be able to use this option for valve replacement.