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What is Percutaneous Aortic Valve Replacement (PAVR / TAVI)

Percutaneous aortic valve replacement (PAVR), also known as transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement(TAVR), is the replacement of the aortic valve of the heart through the blood vessels (as opposed to valve replacement by open heart surgery). This minimally invasive surgical procedure repairs the valve without removing the old, damaged valve. Instead, it wedges a replacement valve into the aortic valve’s place. The surgery may be called a transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI).

Also called transcatheter aortic valve implantation (TAVI) Transcatheter aortic valve replacement (TAVR) is a procedure for select patients with severe symptomatic aortic stenosis (narrowing of the aortic valve opening) who are not candidates for traditional open chest surgery or are high-risk operable candidates. TAVR is performed on a beating heart and does not require cardio-pulmonary bypass.

The TAVR valve is made of bovine (cow) pericardium and is supported with a metal stent.

A) Balloon catheter in the diseased valve
B) Balloon with valve in place
C) Balloon inflation to secure the valve


What is the TAVI / TAVR Procedure?

A catheter is placed in the femoral artery (in the groin) similar to angioplasty, and guided into the chambers of the heart. A compressed tissue heart valve is placed on the balloon catheter and is positioned directly inside the diseased aortic valve. Once in position, the balloon is inflated to secure the valve in place.
This procedure is performed with general anesthesia in a hybrid suite (which has both catheterization and surgical capabilities). A team of interventional cardiologists and imaging specialists, heart surgeons and cardiac anesthesiologists work together, utilizing fluoroscopy and echocardiography to guide the valve to the site of the patient’s diseased heart valve.
The transfemoral approach is now approved by the FDA for patients who have severe, symptomatic aortic stenosis who are ineligible for open surgical replacement, based on the PARTNER-B trial results. It is not approved for patients who are eligible for traditional aortic valve surgery, patients with bicuspid aortic valves, endocarditis, or cannot tolerate anticoagulation/antiplatelet therapy.

How is TAVR or TAVI different from the surgical valve replacement?

This procedure is fairly new and is FDA approved for people with symptomatic aortic stenosis who are considered a high risk patient for standard valve replacement surgery. The differences in the two procedures are significant.


What is involved in a TAVR procedure?

Usually valve replacement requires an open heart procedure with a “sternotomy.”, in which the chest is surgically separated (open) for the procedure. The TAVR or TAVI procedures can be done through very small openings that leave all the chest bones in place.


A TAVR procedure is not without risks, but it provides beneficial treatment options to people who may not have been candidates for them a few years ago while also providing the added bonus of a faster recovery in most cases. A patient's experience with a TAVR procedure may be comparable to a balloon treatment or even an angiogram in terms of down time and recovery, and will likely require a shorter hospital stay (average 3-5 days)

The TAVR procedure is performed using one of two different approaches, allowing the cardiologist or surgeon to choose which one provides the best and safest way to access the valve:

Entering through the femoral artery (large artery in the groin), called the transfemoral approach, which does not require a surgical incision in the chest

or

Using a minimally invasive surgical approach with a small incision in the chest and entering through a large artery in the chest or through the tip of the left ventricle (the apex), which is known as the transapical approach.

Who is a good candidate for this type of valve surgery?

At this time the procedure is reserved for those people for whom an open heart procedure is too risky. For that reason, most people who have this procedure are in their 70s or 80 and often have other medical conditions that make them a better candidate for this type of surgery.
Although relatively new, TAVI can be an effective option to improve quality of life in patients who otherwise have limited choices for repair of their aortic valve.

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