McLaren Health Care
TAVR Surgery

Description

The surgery will be done in a hospital. It will take about 2 to 4 hours.

• Before your surgery, you will receive general anesthesia. This will put you in a pain-free sleep.
• Once asleep, you will have a tube put down your throat connected to a machine to help you breathe. It will be removed after surgery.
• The doctor will make a cut (incision) in an artery in your groin or in your chest near your breastbone.
• If you don't already have a pacemaker, the doctor will put a temporary one in that you will wear for 24 hours after the surgery. A pacemaker helps your heart beat in a regular rhythm. If no complications arise, it will be removed. If deemed necessary, a permanent pacemaker will be placed.
• The doctor will thread a thin tube called a catheter through the artery to your heart and aortic valve.
• A small balloon on the end of the catheter will be expanded in your aortic valve.
• The doctor will then guide a new aortic valve over the catheter and balloon and place it in your aortic valve. A biological valve is used for TAVR.
• The new valve will be opened inside the old valve. It will do the work of the old valve.
• The doctor will remove the catheter and close the cut. Stitches are not generally required.
• You do not need to be on a heart-lung machine for this procedure.

How does the procedure work?

This less invasive procedure is different than open heart surgery. TAVR uses a catheter to replace the heart valve instead of opening up the chest and completely removing the diseased valve. It can be performed in multiple ways. The procedure is achieved through a needle puncture. The incision is commonly made through the femoral vessels in the leg (near the groin) though other options include incisions between the ribs or in the upper chest. During the procedure, an interventional cardiologist and a cardiothoracic surgeon work together. They will guide a new valve into the heart through an incision in the leg while the heart is still beating, using guidance from X-ray and echocardiography. The TAVR procedure allows a new valve to be inserted within a diseased aortic valve. The new valve will push the leaflets of the diseased valve aside. The frame will use the leaflets of the diseased valve to secure it in place.

The most common is through an artery in your leg.  This is called transfemoral TAVR.  See explanation of the procedure, along with a patient success story below.

Transapical TAVR allows the heart valve to be placed by a small incision in the bottom of the heart.  This is usually reserved for patients who cannot have the valve put in through the leg.  See explanation of the procedure, along with a patient success story below.

Why the Procedure Is Performed

TAVR is used for people with severe aortic stenosis who aren't healthy enough to have open chest surgery to replace a valve.

In adults, aortic stenosis usually occurs due to calcium deposits that narrow the valve. This generally affects older people.

TAVR may be done for these reasons:

• You are having major heart symptoms, such as chest pain (angina), shortness of breath, fainting spells (syncope), or heart failure.
• Tests show that changes in your aortic valve are beginning to seriously harm how well your heart works.
• Your heart valve has been damaged by endocarditis (infection of the heart valve).
• You can't have regular valve surgery because it would put your health at risk. (Note: Studies are being performed to see whether more patients could be helped by the surgery.)

This procedure has many benefits. There is less pain, blood loss, and risk of infection. You will also recover faster than you would from open-chest surgery.

Risks

Risks of any anesthesia are:

• Bleeding
• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Infection, including in the lungs, kidneys, bladder, chest, or heart valves
• Reactions to medicines

Other risks are:

• Damage to blood vessels
• Heart attack or stroke
• Infection of the new valve
• Kidney failure
• Abnormal heartbeat
• Bleeding
• Poor healing of incision
• Death
• Need of a permanent pacemaker

Before the Procedure

Always tell your doctor or nurse what medicines you are taking, including over-the counter medicines, supplements, or herbs.

You should see your dentist to make sure there are no infections in your mouth. If untreated, these infections may spread to your heart or new heart valve.

For the 2-week period before surgery, you may be asked to stop taking medicines that make it harder for your blood to clot. These might cause increased bleeding during the surgery.

• Some of them are aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).
• If you are taking warfarin (Coumadin) or clopidogrel (Plavix), talk with your surgeon before stopping or changing how you take these drugs.

During the days before your surgery:

• Ask your doctor which medicines you should still take on the day of your surgery.
• If you smoke, you must stop. Ask your doctor for help.
• Always let your doctor know if you have a cold, flu, fever, herpes breakout, or any other illness in the time leading up to your surgery.
• On the day before your surgery, shower, and shampoo well. You may be asked to wash your whole body below your neck with a special soap. Scrub your chest 2 or 3 times with this soap. You also may be asked to take an antibiotic to prevent infection.

On the day of your surgery:

• You will usually be asked not to drink or eat anything after midnight the night before your surgery. This includes chewing gum and using breath mints. Rinse your mouth with water if it feels dry, but be careful not to swallow.
• Take the medicines your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You can expect to spend 1 to 2 days in the hospital.

You will spend the first night in an intensive care unit (ICU). Nurses will monitor you closely. Usually, within 24 hours, you will be moved to a regular room or a transitional care unit in the hospital.

The day after surgery, you will be helped out of bed so you can get up and move around. You may begin a program to make your heart and body stronger.

Your health care providers will show you how to care for yourself at home. You will learn how to bathe yourself and care for the surgical wound. You will also be given instructions for diet and exercise. Be sure to take any medicines as prescribed. You may need to take blood thinners for the rest of your life.

Your doctor will have you come in for a follow-up appointment to check that the new valve is working well.

Be sure to tell any of your providers that you have had a valve replacement. Be sure to do this before having any medical or dental procedures.

Outlook (Prognosis)

Having this procedure can improve the quality of your life and help you live longer than you might without the procedure. You may breathe easier and have more energy. You may be able to do things you couldn't do before because your heart is able to pump oxygen-rich blood to the rest of your body.

It's unclear how long the new valve will keep working, so be sure to see your doctor for regular appointments.