Transcatheter Aortic Valve Replacement

Also known as TAVR, Transcatheter Aortic Valve Implantation (TAVI)
Transcatheter aortic valve replacement (TAVR) is a procedure to treat aortic stenosis, a type of heart valve disease. TAVR replaces a faulty aortic valve with an aortic valve made from animal tissue. The TAVR procedure does not require open-heart surgery.
Overview

The aortic valve is one of four valves that control blood flow in the heart. The aortic valve specifically controls the blood that runs from the heart through your aorta and to the rest of the body. Over time or because of a congenital heart defect, you can develop aortic stenosis—a type of heart valve disease—which is narrowing of the aortic valve. This narrowing blocks the flow of blood to your body and forces your heart to work harder. You may need TAVR to replace a diseased aortic valve or to repair a replacement aortic valve that no longer works. Your doctor may recommend TAVR if you have a medical condition that makes it too risky to replace the valve during open-heart surgery, which is more invasive.

Cardiologists, or doctors who specialize in the heart, typically perform TAVR in a hospital. Before TAVR, your medical team will measure the valve opening, then give you medicines that relax you or put you to sleep, as well as medicines that prevent abnormal blood clots. During the procedure, your doctor will guide a thin, flexible tube called a catheter to your heart through vessels that can be accessed from the groin or thigh, abdomen, chest, neck, or collar bone. Inside the catheter is a folded replacement valve, which your doctor will implant securely within the old valve. Once your doctor is sure the new valve has been placed correctly, he or she will check for leaks and possible complications, such as a problem in the heart’s electrical signaling.

After a TAVR procedure, your hospital stay may be shorter and you may be able to return to daily activities, such as exercising and driving, sooner than with open-heart surgery. However, TAVR carries some risks, including stroke, damage and bleeding where the catheters were inserted; need for permanent pacemaker due to damage to the heart’s electrical signaling during the procedure; and injury to the kidneys or the heart. Sometimes the new valve leaks because it does not fit well. Your doctor may give you medicine to prevent infection or abnormal blood clots. About a month after the procedure, your doctor will test to check how well the valve is working and how well you are healing. You may need follow-up visits every year to make sure the valve continues working as it should.

How It Works - Transcatheter Aortic Valve Replacement

There are several ways your doctor can perform TAVR, depending on your health and the condition of your blood vessels. Your doctor usually guides a tube with the replacement valve through a blood vessel in your groin or thigh, called the femoral artery.

If your femoral artery is too small or damaged by disease, your doctor may guide the tube through vessels that can be accessed from the chest. This approach is called transapical access. Your doctor may cut into your chest through your breastbone or ribs to access the heart directly through the aorta or through the pointed end of the heart, called the apex.

Less commonly, your doctor may guide the tube through vessels accessed from the abdomen, neck, or collar bone.

  • Abdomen. NHLBI researchers developed this approach, called transcaval access, to make TAVR available to high-risk patients whose leg arteries are too small or diseased for the standard approach. The doctor makes holes in both the vena cava, a major vein in your abdomen, and the nearby aorta. The doctor guides the tube with the replacement valve first through the vein and then through the aorta to the heart. You may be able to stay awake when the medical team does this procedure. This type of TAVR approach may benefit women, whose blood vessels are usually smaller than men’s are.
  • Collar bone. Accessing the heart from the vessel under the clavicle, or collar bone, may be an option if you have had heart surgery before or if you have another condition that makes it more difficult to access other parts of the chest.
  • Neck. With transcarotid access, your doctor will cut into one side of your neck to expose the carotid artery and closely monitor you while opening a hole in the artery for the tube. This type of procedure is rare but may be used when other options will not work.
  • Septum. In rare cases, your doctor will reach the faulty valve by guiding the tube through a blood vessel from your thigh to the heart and poking a hole through the septum, the wall of tissue that separates the right and left atria of the heart.

Your doctor may also use additional techniques to help prevent complications. New approaches to doing TAVR are making the procedure available to more patients.

Research for Your Health

The NHLBI is part of the U.S. Department of Health and Human Services’ National Institutes of Health (NIH)—the Nation’s biomedical research agency that makes important scientific discovery to improve health and save lives. We are committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart, lung, blood, and sleep disorders, including heart valve diseases. Learn about the current and future NHLBI efforts to improve health through research and scientific discovery.

Improving health with current research
- Transcatheter Aortic Valve Replacement

Learn about the following ways the NHLBI continues to translate current research into improved health for people who have heart valve diseases. Research on this topic is part of the NHLBI’s broader commitment to advancing heart and vascular disease scientific discovery.

  • Bringing TAVR to new patient groups. NHLBI researchers developed an innovative way to perform TAVR, called transcaval access. It makes TAVR more available to high-risk patients, especially women, whose femoral arteries are too small or diseased for standard TAVR. Visit New method for performing aortic valve replacement proves successful in high risk patients for more information.
  • Assessing approaches to implementation. We support the careful evaluation of heart valve repair and replacement techniques so that doctors can improve the advice they give patients about their options and incorporate best practices into their training and care.

Advancing research for improved health
- Transcatheter Aortic Valve Replacement

In support of our mission, we are committed to advancing heart valve diseases research in part through the following ways.

  • We perform research. Our Division of Intramural Research and its Cardiovascular Branch conducts research on diseases that affect the heart and blood vessels. Specific projects aim to answer clinically relevant questions in diagnostics, therapeutics, and interventions. The aim of the branch’s Laboratory of Cardiovascular Intervention is to improve the capabilities, safety, and effectiveness of techniques such as TAVR that use catheters to treat cardiovascular disease in adults and children. These techniques make use of real-time cardiac magnetic resonance imaging (MRI) and do not require surgery.
  • We fund research. The research we fund today will help improve our future health. Our Division of Cardiovascular Sciences oversees much of the research on heart valve diseases and valve replacement that we fund, helping us to improve patients’ options. Search the NIH RePORTer to learn about TAVR research the NHLBI is funding.
  • We stimulate high-impact research. The NHLBI Strategic Vision highlights ways we may support research over the next decade.

Learn more about exciting research areas the NHLBI is exploring.

Participate in NHLBI Clinical Trials

We lead or sponsor many studies aimed at preventing, diagnosing, and treating heart, lung, blood, and sleep disorders.

More Information

After reading our TAVR Health Topic, you may be interested in additional information found in the following resources.

Non-NHLBI resources
- Transcatheter Aortic Valve Replacement

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