Valve replacement surgery typically is open-heart surgery that requires placing the patient on a heart-lung machine so the heart can be stopped during the four-hour procedure. For some patients, this may be too risky to attempt.
The TAVR procedure differs from traditional valve replacement surgery in the way that the doctor replaces the damaged valve with the new, artificial valve. Rather than opening the chest wall to access the heart and surgically remove and replace the diseased valve, the doctor makes a small incision in an artery in the groin and threads a thin catheter up the artery. The new valve is then moved through the catheter into position across the diseased valve. After ensuring the valve is correctly positioned, the doctor uses a small balloon to open the valve. The new valve, which is about the diameter of a dime when fully opened, immediately takes over responsibility for controlling the blood flow.
The TAVR procedure typically takes about 2 hours. Traditional surgical valve replacement surgery can take up to 4 hours. Other benefits of the TAVR procedure include less blood loss, a lower risk of infection and a faster recovery time.
The Edwards SAPIEN valve is a collapsible aortic heart valve that can be introduced into the body via a catheter-based delivery system. The valve is designed to replace a patient’s diseased "native" aortic valve without traditional open-heart surgery and while the heart continues to beat. The valve can be implanted in patients using the transfemoral technique (delivered via the femoral artery) or transapical technique (delivered via a small incision between the ribs). See an illustrated description
of the Edwards SAPIEN valve procedure.
More information: Edwards SAPIEN Transcatheter Aortic Heart Valve Fact Sheet
When the aorta, iliac arteries and femoral arteries are of sufficient caliber as determined by CT angiogram, the femoral artery access approach is preferred. For patients with inadequate peripheral vessels, the valve can be delivered with the Ascendra Delivery System via an incision between the ribs through the apex of the heart (transapical procedure). The transaortic approach of direct aortic cannulation has also been used successfully at Providence for deployment of the valve in situations with challenging anatomy.
The aortic valve replacement team at the Providence Heart & Vascular Center includes cardiologists, cardiac surgeons, specially trained nurses and several other specialists who are instrumental in diagnosing and/or treating aortic stenosis.
The team carefully screens each patient to determine which approach is the safest option. Patients undergo a number of tests, including echocardiogram, cardiac catheterization, CT scan, lung function testing and carotid artery ultrasound. The team also evaluates frailty – a formal diagnosis that looks at strength, mobility, nutrition and tissue integrity.
If the team determines that a patient can safely undergo surgery, he or she is scheduled for TAVR. Some patients who are extremely sick or are very petite and have arteries that are too small for a catheter may not be candidates for TAVR.
Please contact Providence Heart & Vascular Center at 907-212-8287.