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Q&A: TAVR with Dr. Aravind Rao
Severe aortic stenosis is a serious heart valve disease that restricts normal blood flow to the entire body. When you have aortic stenosis, your heart valves are not able to fully open and close. As a result and your lungs, brain and body don’t get the oxygen-rich blood they need to function.
Dr. Aravind Rao with CHI St. Vincent Heart Clinic Arkansas explains Transcatheter Aortic Valve Replacement, commonly known as TAVR, a procedure to correct the problem.
What is this procedure?
TAVR is a valve replacement procedure that results in better a better quality of life and longer life. Patients who have had a stroke, chest radiation, open heart surgery, COPD, frailty, kidney disease, advanced age and other conditions may be appropriate for TAVR.\
How do you determine who is the best candidate for TAVR?
We use a team approach. The patient meets with a cardiologist, and two separate surgeons to help determine the right approach. Other members of the team include the TAVR nurse coordinator, anesthesiology, cath lab and operating room staff and imaging specialists. CHI St. Vincent’s interdisciplinary heart team meets weekly to review cases and plan the best approach for each patient.
The screening process for TAVR is extensive, and includes a complete medical history, an EKG, and an echocardiogram. If the patient is a good candidate for TAVR, cardiac catheterization is performed to exclude significant coronary artery disease. A CT of the chest is performed to evaluate the anatomy of the heart.
Other tests may include a CT of the abdomen and pelvis, a chest x-ray, ultrasound of the arteries in the neck, and lung function studies. Other studies may be ordered by the physicians based on an individual’s specific conditions.
TAVR Screening Process
Complete Medical History
What actually happens during the procedure?
This minimally invasive surgical procedure repairs the valve without removing the old, damaged valve. Instead, it wedges a replacement valve into the aortic valve place.
What happens if I don’t have the valve replaced?
Patients may live with aortic stenosis for many years with no symptoms. But once symptoms begin prompt treatment is needed. Without treatment patients have an increased risk of death. That risk is about 25 percent for the first year after symptoms begin and then 50 percent two years after symptoms begin.
Valve replacement is sometimes done with open heart surgery, but TAVR is not open heart surgery. What are the advantages?
Some of the advantages of TAVR include shorter hospital stays and quicker recovery times. In addition, many TAVR procedures are done under sedation instead of general anesthesia.
What are the risks of TAVR?
As with any procedure, there are a few risks. Some of the risks for TAVR include bleeding at the catheter insertion site, vascular damage, infection, abnormal heart rhythms and stroke. These and other risks will be discussed during the screening process.
Abnormal heart Rhythm
What is the typical hospital stay?
Typically a patient will spend about one to five days in the hospital, depending on the approach used in the TAVR procedure.
Are there any major restrictions after the procedure?
Each patient receives detailed instructions after the procedure to ensure a full recovery. They are encouraged to stay active during the recovery process. While on pain medication, patients are discouraged from driving or operating heavy machinery.
What are the chances of “curing” heart valve disease with TAVR?
The only effective treatment for severe aortic stenosis is to completely replace the diseased aortic valve.