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Transcatheter Aortic Valve Replacement (TAVR)

 

Minimally invasive transcatheter aortic valve replacement (TAVR) available at JCMC.

For all patients suffering from severe aortic stenosis, unless determined to be at low surgical risk for traditional open heart surgery, transcatheter aortic valve replacement (TAVR) may be a treatment option. TAVR is a less invasive procedure that does not require open heart surgery. During the TAVR procedure, a prosthetic valve is inserted within the native, diseased aortic valve. The TAVR procedure can be performed through multiple approaches (eg. transfemoral, transapical, or transaortic). This procedure was approved in Europe in 2007 and by the FDA in the U.S. in 2011. 

 

Benefits of TAVR:

  • Relief of symptoms, in some cases immediately
  • Reduction in pain and anxiety
  • Improved heart function
  • May shorten recovery time to resume everyday activities

Quality of Life Improvement:

TAVR has shown improvement in a patient's health as early as 30 days after their procedure. Patients reported improvements in quality of life, including:

  • Ability to take care of themselves
  • Ability to participate in everyday activities
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Aortic Stenosis Facts

The population at risk for aortic stenosis is growing. It is estimated that 2.5 million people in the US over the age of 75 suffer from this disease,1 which is about 12.4% of that population.2 The elderly population will more than double between now and the year 2050, to 80 million.3 Aortic stenosis is also more likely to affect men than women. 80% of adults with symptomatic aortic stenosis are male.5

Severe Aortic Stenosis is Life Threatening and Treatment is Critical6

Patients may live with aortic stenosis for many years during a latent, asymptomatic period, even before symptoms of the disease develop and present. However, after patients begin experiencing symptoms, it is urgent they receive treatment. After the onset of symptoms, patients with severe aortic stenosis have a survival rate as low as 50% at 2 years and 20% at 5 years without aortic valve replacement.5

Impact of Untreated, Symptomatic Aortic Stenosis on Patients

  • Quality of Life is Significantly Impacted: Patients with severe aortic stenosis often develop symptoms that can restrict normal day-to-day activities, such as walking short distances or climbing stairs. These patients can often benefit from replacing their ailing valve, but only approximately two-thirds of them undergo the procedure each year.7
  • Timely Intervention is Critical for Patients with Symptoms8: Once symptoms appear, untreated patients have a poor prognosis.8 Without treatment, symptomatic aortic stenosis will eventually lead to death.

Symptoms and Diagnosing Aortic Stenosis

Multiple modalities may be used to diagnose whether the patient's aortic stenosis Is severe. Echocardiographic guidelines are the gold standard in diagnosing a patient with severe aortic stenosis.1

Because timely intervention is so important, it’s critical to achieve proper diagnosis for patients that may be exhibiting symptoms of aortic stenosis. Detection and estimation of disease severity can often be first achieved by auscultation. The symptoms of aortic disease are commonly misunderstood by patients as "normal" signs of aging. Many patients initially appear asymptomatic, but on closer examination, up to 32% exhibit symptoms.2

  • Shortness of breath
  • Syncope or presyncope
  • Angina
  • Fatigue
  • Difficulty when exercising
  • Swollen ankles and feet
  • Rapid or irregular heartbeat
  • Palpitations (an uncomfortable awareness of heart beating rapidly or irregularly)

However, severe aortic stenosis may occur with no outward symptoms.


Content courtesy of Edwards and NewHeartValve.com
Aortic Stenosis Facts through Impact of Untreated, Symptomatic Aortic Stenosis on Patients References:
1. U.S. Census Bureau, Population Division. June 2015. 
2. Osnabrugge, Ruben L.J., et al. Aortic Stenosis in the Elderly. Disease Prevalence and Number Candidates for Transcatheter Aortic Valve Replacement: A Meta-Analysis and Modeling Study. J Am Coll Cardiol. 2013;62:1002-1012.
3. U.S. Census Bureau Statistical Brief. May 1995. 
4. Ramaraj R, Sorrell V. Degenerative aortic stenosis. BMJ 2008;336:550-5.
5. Otto C. VALVE DISEASE: Timing of aortic valve surgery. Heart. 2000;84(2):211-218.
6. Lester S, Heilbron B, Dodek A, Gin K, Jue J. The Natural History and Rate of Progression of Aortic Stenosis. Chest. 1998;113(4):1109.
7. Bach D, Siao D, Girard S, Duvernoy C, McCallister B, Gualano S. Evaluation of Patients With Severe Symptomatic Aortic Stenosis Who Do Not Undergo Aortic Valve Replacement: The Potential Role of Subjectively Overestimated Operative Risk. Circ Cardiovasc Qual Outcomes. 2009;2(6):533-539. 
8. Nishimura R, Otto C, Bonow R, et al. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary. J Am Coll Cardiol. 2014;63(22):2438-2488.
9. National Cancer Institute. SEER Cancer Stat Fact Sheets. Seercancergov. Available at: http://seer.cancer.gov/statfacts/. Accessed November 16, 2010.
10. Stewart B, Siscovick D, Lind B, et al. Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol. 1997;29(3):630-634.
11. Freed B, Sugeng L, Furlong K et al. Reasons for Nonadherence to Guidelines for Aortic Valve Replacement in Patients With Severe Aortic Stenosis and Potential Solutions. Am J Cardiol. 2010;105(9):1339-1342. 
12. Bouma B, van den Brink R, van der Meulen J, et al. To operate or not on elderly patients with aortic stenosis: the decision and its consequences. Heart. 1999;82(2):143-148. 
13. Pellikka P, Sarano M, Nishimura R, et al. Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up. Circulation. 2005;111(24):3290-3295.
14. Charlson E, Legedza A, Hamel M. Decision-making and outcomes in severe symptomatic aortic stenosis. J Heart Valve Dis. 2006;15(3):312-321.
15. Varadarajan P, Kapoor N, Banscal RC, Pai RG. Clinical profile and natural history of 453 nonsurgically managed patients with severe aortic stenosis. Ann Thorac Surg. 2006;82(6):2111-2115.
16. Jan F, Andreev M, Mori N, Janosik B, Sagar K. Unoperated patients with severe symptomatic aortic stenosis. Circulation. 2009;120;S753.

Symptoms and Diagnosing Aortic Stenosis References: 
1. Saikrishnan N, Kumar G, Sawaya F, Lerakis S, Yoganathan A. Accurate assessment of aortic stenosis: a review of diagnostic modalities and hemodynamics. Circulation. 2014;129(2):244-253.
2. Das P, Rimington H, Chambers J. Exercise testing to stratify risk in aortic stenosis. Eur Heart J. 2005;26(13):1309-1313.