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Transcatheter Aortic Valve Replacement

Innovative Heart Care Procedure, Close to Home

If you’ve been diagnosed with aortic stenosis, but are considered an intermediate or high risk for surgery, transcatheter aortic valve replacement (TAVR) may be the solution you need to greatly improve your condition and quality of life. At Saint Vincent Hospital, our multidisciplinary team is able to offer this lifesaving procedure to otherwise inoperable patients in our state-of-the-art hybrid catheterization room.

One of the features that makes our TAVR program unique is the ability to perform the procedure under moderate sedation rather than general anesthesia. This approach lessens the risk associated with anesthesia.

What is TAVR?

TAVR is a newly developed procedure used to treat aortic stenosis, a condition that occurs when the one-way valve between the pumping chamber of the heart and the aorta becomes thickened and calcified, not opening well. In less serious cases, patients are able to undergo valve replacement surgery to help the condition. For patients with severe valve narrowing and older adults, the surgery risk may be too high. That’s where TAVR comes in.

Over the last few years, TAVR has been developed to provide a minimally invasive solution for high-risk patients. During this procedure, a new valve is placed through the blood stream, and a new valve is expanded within the patient’s own diseased valve. Usually this procedure is done the femoral (groin) blood vessels, but if you have extensive blood vessel disease, it may need to be done through an incision in the chest to place the new valve directly through the heart muscle.

Am I a Candidate?

TAVR is only for patients who are at high or intermediate risk for surgery and for those who are unable to have surgery. This procedure is only for aortic stenosis, not aortic regurgitation, as the calcification of the diseased valve is used to keep the new valve in place. TAVR requires that the diseased valve have three leaflets, not congenitally abnormal bicuspid (two leaflet) valves. TAVR is not approved for low-risk patients at this time. Surgical valve replacement is currently offered to patients considered to be at low risk because of the excellent long-term benefits of surgery.

TAVR Process: What to Expect

If your doctor suspects that you have severe aortic stenosis, especially if you are symptomatic, an echocardiogram is usually performed.  A referral to our Advanced Structural and Valvular Heart Disease program can provide you with an evaluation by our TAVR cardiologists and cardiothoracic surgeons.

We’ll review the outside echocardiogram or obtain one at Saint Vincent Hospital. If our team believes that your surgical risk is high and you might do better with a TAVR procedure, additional testing, including a specialized computed tomographic angiogram and cardiac catheterization, will be performed. Once additional testing has been completed, a follow-up evaluation will occur to review the testing results and discuss TAVR procedure options.

Preparing for the Procedure

The procedure is usually performed under general anesthesia under the supervision of a cardiac anesthesiologist. During preadmission testing, you’ll meet with an anesthesiologist who will also review your history, medications and lab tests. Some patients require admission the day before the procedure and others may be admitted the morning of the procedure. Instructions on preparing and arriving for your procedure will be given to you in advance.

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A Guide to Heart Screenings

Woman forming heart with handsTo evaluate your heart, your doctor may order one or more of these tests.

Electrocardiogram (EKG/ECG)
Electrodes (small, plastic patches) are placed at certain locations on your chest, arms and legs and are connected to a machine by lead wires.

What it shows
Possible irregularities in the electrical activity of your heart.

Echocardiogram (echo)
A hand-held device placed on your chest uses high-frequency sound waves (ultrasound) to produce images of your heart's size, structure and motion.

What it shows
Possible abnormalities in heart valves and vessels, or if there are tumors or clots.

Holter monitoring

You’ll be asked to wear a battery-operated EKG for 24 to 48 hours.

What it shows
Possible irregularities in your heart’s electrical rhythms that are only detected with a longer period of monitoring.

Cardiac computed tomography
This fast version of a CT (computerized tomography) scan produces multiple images of your beating heart from many different angles. In some cases, contrast dye (iodine) is injected before the test.

What it shows
Possible problems in your heart’s structure and in how your heart pumps blood. If contrast dye is used, the test can also detect blockage in your arteries.

Exercise stress test
You exercise on a treadmill while having an electrocardiogram. You start slowly and gradually increase your speed and intensity.

What it shows
How well your heart functions while it’s working

Thallium stress test
While undergoing an exercise stress test, a radioactive substance (thallium) is injected into your veins through an IV, and a special camera takes images of your heart.

What it shows
Blood flow into your heart at rest and during stress. It can also determine the extent of any coronary artery blockages.

Please talk with your doctor to find out if you need a heart screening test.