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🫀 Understanding TAVR (Transcatheter Aortic Valve Replacement)

What is TAVR?

TAVR (Transcatheter Aortic Valve Replacement) — also called TAVI (Transcatheter Aortic Valve Implantation) — is a minimally invasive procedure used to treat severe aortic stenosis, a condition in which the aortic valve becomes narrowed and restricts blood flow from the heart to the body.

Instead of open-heart surgery, TAVR delivers a new valve through a catheter (usually inserted through the femoral artery in the groin) and expands it inside the diseased valve.

What Is Aortic Stenosis?

Aortic stenosis (AS) occurs when the aortic valve becomes thickened or calcified and does not open fully. Over time, this forces the heart to work harder and can lead to:

• Shortness of breath

• Chest pain (angina)

• Dizziness or fainting

• Fatigue

• Heart failure

Severe symptomatic aortic stenosis has a high mortality rate if left untreated.

Who Is a Candidate for TAVR?

TAVR was originally approved for patients considered high or prohibitive surgical risk, but research has expanded its use.

Today, TAVR is approved for:

• High-risk patients

• Intermediate-risk patients

• Selected low-risk patients

• Some patients with prior bioprosthetic valve failure (valve-in-valve procedures)

A multidisciplinary heart team (cardiologist + cardiothoracic surgeon) evaluates candidacy based on:

• Age

• Frailty

• Anatomy

• Comorbidities

• Surgical risk score

Benefits of TAVR

Compared to traditional surgical aortic valve replacement (SAVR), TAVR typically offers:

• Shorter hospital stays (often 1–2 days)

• Faster recovery time

• Less invasive access

• Similar survival rates in many risk groups

• Significant symptom improvement

Potential Risks

Like any procedure, TAVR carries risks, including:

• Stroke

• Bleeding

• Vascular complications

• Need for permanent pacemaker

• Paravalvular leak

Careful patient selection significantly reduces these risks.

TAVR vs. Open-Heart Surgery (SAVR)

Feature	TAVR	Surgical AVR
Incision	Catheter-based	Sternotomy
Recovery	Days to weeks	6–12 weeks
Anesthesia	Often conscious sedation	General anesthesia
Best for	Many risk levels	Younger patients or certain anatomies

Outcomes & Evidence

Major trials that shaped TAVR practice include:

• PARTNER Trials (Placement of Aortic Transcatheter Valves)

• CoreValve / Evolut Trials

• Low-risk randomized trials showing non-inferiority (and in some cases superiority) to surgery in selected patients

Long-term durability data (10+ years) continues to evolve but is encouraging for many patients.

Important Considerations

• Lifelong follow-up with cardiology is essential

• Antiplatelet therapy is typically required post-procedure

• Valve durability and future intervention planning should be discussed, especially for younger patients

Why Awareness Matters

Severe aortic stenosis is often underdiagnosed. If you or a loved one experiences unexplained shortness of breath, chest pain, or fainting — especially over age 65 — evaluation with echocardiography is critical.

Early diagnosis and appropriate referral to a structural heart team can be lifesaving.

📚 References

1. American College of Cardiology / American Heart Association. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease. Circulation. 2021.

2. Mack MJ, et al. Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients. New England Journal of Medicine. 2019. (PARTNER 3 Trial)

3. Popma JJ, et al. Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients. New England Journal of Medicine. 2019.

4. Otto CM, et al. 2020 ACC/AHA Guideline for Valvular Heart Disease. Journal of the American College of Cardiology. 2021.

5. Society of Thoracic Surgeons Adult Cardiac Surgery Database Reports.