What is Transcatheter Aortic Valve Replacement (TAVR)

Transcatheter aortic valve replacement is a procedure to place an artificial aortic valve in the heart. The aortic valve controls blood flow between the heart and the main blood vessel that supplies blood to the body (aorta).

During TAVR, a flexible tube (catheter) is placed through an incision in the groin, chest, or neck and is guided to the aortic valve. Then, the artificial valve is moved through the catheter and into the aortic valve, where it is expanded. The new valve takes over the function of the old valve, and it improves blood flow through the heart.

This procedure is also called transcatheter aortic valve implantation (TAVI). You may need TAVR if you have a stiff aortic valve (aortic stenosis) that is causing symptoms and open heart valve replacement surgery is not an option for you.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Bleeding.
• Damage to blood vessels or the heart.
• Stroke.
• Blood clots.
• Abnormal heart rhythms (arrhythmia).
• Heart attack.
• Allergic reactions to medicines or dyes.
• Infection.
• Kidney failure.
• Failure of the artificial valve.

What happens before the procedure?

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• You may be given antibiotic medicine to help prevent infection.
• You may need to take blood thinners before surgery. If so, take these medicines as directed.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

General instructions

• Do not use any products that contain nicotine or tobacco for as long as possible before your procedure. These include cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• You may have a blood or urine sample taken.
• You may have tests, such as:
  • Echocardiogram. This is an ultrasound scan of the heart.
  • CT scan.
  • Cardiac catheterization. During this procedure, a catheter is inserted into a blood vessel and guided into your heart to check pressures and take images of the heart.
  • Lung function tests.
• Plan to have someone take you home from the hospital.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• IV tubes will be inserted into veins in your arms.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area (local anesthetic).
  • A medicine to make you fall asleep (general anesthetic).
• Small incisions will be made in one or more of the following places:
  • Your groin. This is the most common.
  • Your neck.
  • In your chest, over your breastbone (sternum).
  • The left side of your chest.
• Catheters will be threaded into your incisions and into blood vessels that lead to your heart. If your incision is in the left side of your chest, a catheter will be placed directly into your heart. Catheters will be used to monitor your heartbeat and regulate it if necessary (pacemaker).
• Ongoing X-ray images (fluoroscopy) will be used to guide the catheters to the right places in your heart.
• A wire may be placed through the catheter inside your aortic valve. A balloon at the end of this catheter may be inflated to open your aortic valve. This wire will then be removed.
• Another wire will be placed through the catheter inside your aortic valve. The wire will be used to help position and inflate your artificial valve. Then, the wire will be removed.
• Tests will be done to make sure your new valve is working and your heart is functioning properly.
• Your incisions will be closed with stitches (sutures), skin glue, or adhesive strips.
• If you had an incision in your chest wall, you may have a chest tube placed to keep your lung from collapsing.
• Bandages (dressings) will be placed over your incisions.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored.
• You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
• You may need to lie still in bed for several hours. Once you are allowed to get up, you will be encouraged to move around.
• If you had a chest incision, you will have some chest pain. You will be given pain medicine as needed.
• You may continue to receive fluids and medicines through an IV tube.
• You will be given blood thinners.
• You will be shown how to do breathing exercises to prevent lung infection.
• You may continue to have a chest tube draining fluid from the surgical area.
• Do not drive for 24 hours if you were given a sedative.

Summary

• Transcatheter aortic valve replacement (TAVR) is a procedure to place an artificial aortic valve in the heart.
• You may need TAVR if you have a stiff aortic valve (aortic stenosis) that is causing symptoms and open heart valve replacement surgery is not an option for you.
• After the procedure, you may need to lie still in bed for several hours. Once you are allowed to get up, you will be encouraged to move around.

Transcatheter Aortic Valve Replacement, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain around your incision areas.
• Bruising and a small lump near your catheter insertion area as it heals.

Follow these instructions at home:

Eating and drinking

• Follow instructions from your health care provider about eating or drinking restrictions.
  • Limit alcohol intake to no more than 1 drink per day for nonpregnant women and 2 drinks per day for men. One drink equals 12 oz of beer, 5 oz of wine, or 1½ oz of hard liquor.
  • Limit how much caffeine you drink. Caffeine can affect your heart’s rate and rhythm.
• Eat a heart-healthy diet. This includes low-fat (lean) proteins, whole grains, and plenty of fresh fruits and vegetables. Avoid foods that are:
  • High in salt (sodium), saturated fat, or sugar. Check ingredients and nutrition facts on packaged foods and beverages.
  • Canned or highly processed.
  • Fried.
• Drink enough fluid to keep your urine pale yellow.

Activity

• Take naps and rest as needed throughout the day.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Exercise regularly, as told by your health care provider.
• Be sure to get up and move around one or more times every 1–2 hours. This helps to prevent blood clots.
• Avoid climbing stairs for about 1 week.
• Do not lift anything that is heavier than 10 lb (4.5 kg) until your health care provider approves.

Incision care

• Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
  • Wash your hands with soap and water before you change your bandages (dressings). If soap and water are not available, use hand sanitizer.
  • Change your dressings as told by your health care provider.
  • Leave stitches (sutures) or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision areas every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

Travel

• Avoid airplane travel for as long as told by your health care provider.
• When you travel, bring a list of your medicines and a record of your medical history with you.

Driving

• Ask your health care provider when it is safe for you to drive. Do not drive until your health care provider approves.
• Do not drive for 24 hours if you were given a medicine to help you relax (sedative) during your procedure.
• Do not drive or use heavy machinery while taking prescription pain medicine, unless your health care provider approves.

Lifestyle

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Resume sexual activity as told by your health care provider. Do not use medicines for erectile dysfunction unless your health care provider approves, if this applies.
• Work with your health care provider to keep your blood pressure under control and to manage any other heart conditions that you have.
• Maintain a healthy weight.

General instructions

• Do not take baths, swim, or use a hot tub until your health care provider approves.
• Do not strain to have a bowel movement.
• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
• Tell all of your health care providers that you have an artificial aortic valve. If you have or have had heart disease or endocarditis, tell all health care providers about these conditions as well.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You develop a skin rash.
• You experience sudden, unexplained weight changes.
• You have redness, swelling, or pain around an incision area.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from an incision area.
• You have a fever.

Get help right away if:

• Your incision area swells very quickly.
• Your incision is bleeding, and the bleeding does not stop after holding pressure on the area.
• The area near or just beyond your incision tingles or becomes pale, cool, or numb.
• You develop chest pain.
• You develop shortness of breath or have difficulty breathing.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

• After the procedure, it is common to have discomfort and bruising around the catheter insertion site.
• Avoid climbing stairs for about 1 week after your procedure.
• Do not lift anything that is heavier than 10 lb (4.5 kg) until your health care provider approves.
• Tell all of your health care providers that you have an artificial aortic valve.