Transcatheter Aortic Valve Replacement (TAVR)

Transcatheter aortic valve replacement treats aortic stenosis — an aortic valve so narrowed that the heart struggles to push blood out to the body. Instead of opening the chest, a replacement valve mounted on a collapsible frame is threaded through a catheter, positioned inside the diseased valve, and expanded. The new valve pushes the old leaflets aside and takes over immediately.

Severe symptomatic aortic stenosis is dangerous once symptoms begin, and no medication treats it. TAVR made valve replacement possible for many patients who could not undergo open surgery, and it is now an established option across a broad range of surgical risk.

Aortic stenosis typically causes breathlessness on exertion, chest pressure, fatigue, lightheadedness or fainting. Once symptoms appear, replacing the valve is what changes the outlook. TAVR is also considered for selected patients before symptoms if testing shows the heart is being harmed.

Whether TAVR or surgical replacement is better depends on your age, anatomy, valve type, other heart disease and overall health. That decision is made by a heart team — an interventional cardiologist and a cardiac surgeon together — rather than by any one specialist, and a cardiac CT is central to it.

Preparation includes a cardiac CT to size the valve and map the access arteries, an echocardiogram, and usually a coronary angiogram to check whether any blockages need treating first.

The procedure commonly takes one to two hours. Most are performed through the femoral artery in the groin under conscious sedation with local anesthetic; alternative access routes are used when the leg arteries are unsuitable. A temporary pacing wire is placed, since the heart is paced rapidly for a few seconds while the valve is deployed. The old valve is not removed — the new one is seated within it.

Many patients are up and walking the same day and go home in one to two days, a recovery markedly shorter than open surgery.

Care for the groin site, avoid heavy lifting and strenuous activity for about a week, and expect energy to return over several weeks. Most people notice their breathing improve quickly. Cardiac rehabilitation is recommended.

You will take antiplatelet or anticoagulant medication afterward — which one and for how long depends on whether you have another indication such as atrial fibrillation. Follow-up echocardiograms track how the valve is functioning over time.

The main ones are the need for a permanent pacemaker, because the new valve sits next to the heart's conduction system and can disturb it — this is more common with TAVR than with surgery and is discussed specifically beforehand. Others include bleeding or injury to the access artery, stroke, kidney injury from contrast, leakage around the edge of the new valve, and rarely valve malposition or the need for emergency surgery.

Durability is the honest open question for younger patients: surgical tissue valves have decades of follow-up, TAVR valves fewer. This is a central part of the heart team discussion when the patient has many years ahead, along with whether a future valve-in-valve procedure would remain possible.

With any replacement valve, tell every clinician and dentist that you have one. Antibiotics before certain dental and surgical procedures are recommended to reduce the risk of a valve infection, and any unexplained persistent fever warrants prompt evaluation.