Dr. Neeraj Bhalla
Director & Sr. Consultant
Cardiology
BLK Heart Centre
BLK Super Speciality
Hospital, New Delhi

TAVR (Transcatheter Aortic Valve Replacement), also known as TAVI, is a valve-replacement procedure for the aortic valve. The narrowing of the aortic valve is known as Aortic Stenosis. The causes of Aortic Stenosis could be various including birth defect, rheumatic fever, radiation therapy and increased calcium deposits. Due to the stenosis, there is reduced blood flow to the rest of the body and it affects the pressure in the left atrium. It is important to note that most people don’t feel the symptoms of Aortic Stenosis until the restricted blood flow has been significant. Symptoms include breathlessness, chest pain, blackouts and heart murmur.

If there are no symptoms along with mild stenosis, the doctor may advise non-invasive treatments such as medication, long term monitoring, elimination of extra fluids. If the extent of your Aortic Stenosis is severe, you may be advised surgery. The two types of surgery are Open Heart Valve Replacement (surgical valve replacement) and TAVR. Since TAVR is a newer approach, the long-term benefits are unknown. Therefore, if you are at a low risk, your doctor may opt for Surgical Valve Replacement.

TAVR is mostly recommended for those who are at intermediate to high risk of complications from Surgical Valve Replacement. It is also recommended for elderly patients as well as for those who have comorbidity such as kidney disease, diabetes, lung disease. It is also ideal for those who previously have had Open Heart Surgery or those whose health has not improved despite medications.

THE PROCEDURE

Under general anaesthesia, a balloon catheter equipped with the replacement valve (porcine or bovine) is inserted either into the femoral artery near the groin (transfemoral) or into a large artery in the chest via a small incision (transpacial). The catheter is passed into the heart and placed at the position of the aortic valve. The balloon is inflated, to push away the damaged tissue, making room for the new valve. The new valve expands, sitting inside the damaged valve and the deflated balloon and catheter is removed.

ADVANTAGES

The advantages of TAVR include, shorter recovery time as the patient usually gets discharged within 2-3 days post the intervention, reduced risk of stroke and fatality as compared to Surgical Valve Replacement in medium-high risk patients and no major incision in the chest. In TAVR, a heart-lung machine is also not used.