Many older patients with heavy calcium deposits on their heart’s aortic valve (a condition called aortic stenosis, or AS) are considered too high risk for valve replacement surgery. Today, these patients have an option in transcatheter aortic valve replacement (TAVR).
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TAVR is a method of inserting a new aortic valve within a damaged valve through a catheter in a special cath lab. Once the stent is positioned inside the old valve, it is either expanded by a balloon or expands by itself.
The results of all TAVR procedures performed in the U.S. since 2002—more than 28,000 to date—are kept in a single database. The information has already helped refine the technology and define who benefits from it.
“Ultimately, the knowledge will allow us to serve our patients better,” says Cleveland Clinic cardiologist and TAVR specialist E. Murat Tuzcu, MD.
Although the TAVR procedure carries a risk of several major problems, there has been good progress made to help prevent these complications.
Valves are now uniformly delivered through smaller sheaths, which has reduced the risks of stroke and vascular complications. Some new stents are repositioned after they are deployed. The latest generation of valves is designed to fit irregular natural valves, eliminating aortic regurgitation altogether.
In all cases, better patient selection and advance preparation to prevent the complications have decreased their incidence.
Who is a TAVR candidate?
The most appropriate treatment for any patient with AS should be made by a multidisciplinary team with experience in treating the problem with medications, surgery and TAVR.
“If the risk for surgery is not high, surgical valve replacement should be recommended. If the risk is high or extreme, TAVR will be appropriate,” says Dr. Tuzcu.
In the near future, TAVR might even become the gold standard for aortic valve replacement. It is already being used in patients whose bioprosthetic replacement valve has failed—a technique called valve-in-valve TAVR.
Its value is also being assessed in patients at moderate surgical risk, as well as those with severe AS and coronary artery disease and in patients with aortic regurgitation.
“We are very excited about these emerging indications for TAVR,” says Dr. Tuzcu.