It's Topic Tuesday!

Welcome, everyone! I hope life has been treating you well, my name is Alvaro and Today, we’re diving into Transcatheter aortic valve replacement (TAVR), a minimally invasive procedure that repairs damage to the aortic valve in your heart. 

What is a Transcatheter aortic valve replacement (TAVR)? 

Transcatheter aortic valve replacement (TAVR)  is a minimally invasive procedure to treat the  aortic valve in your heart. Imagine your aortic valve as a tunnel that allows cars (blood) to exit the heart and travel to the rest of the body.  In a healthy person, this tunnel is wide open, letting traffic flow smoothly. However, with aortic stenosis, the entrance of the tunnel becomes narrow and stiff, much like a collapsing tunnel that only allows a few cars through at a time. This creates a traffic jam behind the tunnel, forcing the heart to work harder and causes delays in delivering supplies to the city beyond, reducing blood flow to the body. Instead of shutting down and rebuilding the tunnel from scratch like in open-heart surgery, TAVR works by inserting a fully functional, pre-made tunnel inside the damaged one. This new tunnel expands outward, pushing the collapsed walls aside and restoring normal traffic flow. As a result, the heart no longer has to strain, blood circulation improves, and the body gets the oxygen it needs—all without the need for major surgery. 

i in this type of surgery 

TAVR. Cleveland Clinic n.d. (accessed February 22, 2025).

What does TAVR treat?

Its main use is for aortic valve replacement in aortic stenosis. This is the narrowing of your aortic valve or the area around it. This usually happens due to age-related wear and tear  (especially if you’re over age 70) that can result in calcium buildup and/or thickening of the valve. Other uses include rheumatic heart disease, a condition that happens after an autoimmune reaction to a streptococcal infection that damages the aortic valve, or bicuspid aortic valve, a condition where the aortic valve only has 2 flaps instead of the usual 3.

Who is a candidate for TAVR?

• Aortic valve narrowing (aortic valve stenosis)

• Bicuspid aortic valve (BAV), along with aortic stenosis

• A prior valve replacement that is wearing out

• Most patients over age 65 with aortic stenosis

•  Older patients and those with underlying health conditions

TAVR  is an option for people who are unable to tolerate open surgery due to their age or other health conditions.

What is inside of the valves used in TAVR?

Multiple transcatheter aortic valves are available on the market. However, the only two currently FDA-approved, The SAPIEN valves by Edwards Lifesciences are balloon-expandable and made from bovine tissue and a chromium cobalt alloy frame. The self-expandable EVOLUT-R valve by Medtronic is made from porcine tissue and a nitinol frame and can be repositioned after deployment. If you see in TAVR you can't use mechanical valves like in open surgery you are limited to bioprosthetic valves.

What happens during  TAVR?

Since TAVR  is a minimally invasive procedure this means it's made by a small cut and these are the steps.

1. Anesthesia is given to prevent pain and numb the body. 

2. Make a small cut and insert a thin tube (catheter) into the femoral artery at your upper thigh (they can use a different entry point if they need to)

3. Thread the catheter up to your heart

4. Using X-rays as a guide the catheter 

5. After that they will place the new valve inside your old aortic valve and expand it (the new valve will fit into place and stay there, while the old valve will stay behind the new one that pushed it aside

6. The catheter will be removed and the incision closed. 

What are the risks of TAVR?

TAVR  risks include stroke,  infection,blood vessel injury, bleeding, electrical system disruption that may require a pacemaker,  and a leak around the outer edge of the new valve. Traditional surgery may be needed.

What happens after  TAVR?

After the procedure, Most people can leave the hospital within one day. Some may stay two days or more. The overall TAVR recovery time can vary depending on your case and your overall health.

Fun Fact: The first TAVR procedure was performed in France in 2002 by Alain Cribier, M.D. 

This is all we have for you today folks. We hope this has been informative. Join us back here next Tuesday 

ATT 

ALVARO JOSE MARTINEZ SANTACRUZ 

Bibliography

[1] TAVR. Cleveland Clinic n.d. https://my.clevelandclinic.org/health/treatments/17570-transcatheter-aortic-valve-replacement-tavr (accessed February 22, 2025).

[2] Transcatheter Aortic Valve Replacement. Nih.gov n.d. https://www.ncbi.nlm.nih.gov/sites/books/NBK431075/ (accessed February 22, 2025).

[3] Biancari F, D’Errigo P, Barbanti M, Badoni G, Tamburino C, Polvani G, et al. Ten-year outcomes after transcatheter or surgical aortic valve replacement in low-risk patients: The OBSERVANT study. Int J Cardiol Heart Vasc 2024;55:101545. https://doi.org/10.1016/j.ijcha.2024.101545.

[4] Transcatheter aortic valve implantation: Periprocedural and postprocedural management. Uptodate.com n.d.

https://www.uptodate.com/contents/transcatheter-aortic-valve-implantation-periprocedural-and-postprocedural-management?search=tavi&topicRef=110074&source=see_link (accessed February 22, 2025).