Aortic heart valves, which are compromised by calcium buildup, can be replaced without the traditional method of an 8-inch incision and sawing the chest open to get to the heart. McLeod Cardiothoracic Surgeon Dr. Cary Huber explains the technique – transcatheter aortic valve replacement or TAVR
Watch this short video to see a new heart valve being replaced through the TAVR method.
There’s an approach called a transcatheter aortic valve replacement. It’s really revolutionized the way we take care of patients with aortic valve disease.
The traditional way to perform the operation is called a sternotomy. We make an incision from the top to the bottom of the breastbone. We saw through the breastbone, the sternum, allowing the heart to be exposed. The other way of doing this — although it’s rare — is to make a smaller incision on the right side of the chest and operate in between the ribs. However, both of these operations require the heart-lung machine.
For the traditional approach, we can use a valve made from the lining of a cow’s heart, called a bovine pericardial valve. It’s a very durable valve and has been around for decades. We can also use pig valves. Those are called bio-prosthetic valves.
The other type is a mechanical heart valve that is made out of a very strong carbon fiber product. They are very durable. The downside to the mechanical valve, however, is that you are required to take a blood thinner called Coumadin every day for the rest of your life. If you don’t that valve will clot and that blood clot could potentially travel to the brain causing a stroke. The good news about mechanical valves, though, is you really can’t wear them out.
So, what is TAVR? (TAH-ver) That stands for transcatheter aortic valve replacement. TAVR is approved for intermediate and high-risk patients. It’s also approved for patients with failed or worn-out pig or cow valves. Previously, if I was talking to a 50-year-old patient, I knew their replacement valve wasn’t going to last a lifetime. But now, I could put a pig or cow valve in knowing that in 15, 20 or 25 years (when those valves wear out), those patients can have their valve replaced with a TAVR procedure.
We perform this procedure through the artery in the groin. No knife, just a needle. The most common way to do this is transfemoral (through the artery in the thigh). Another approach would be the subclavian artery or through the carotid artery in the neck.
We have performed over 100 TAVR procedures all with no general anesthesia, just conscious sedation, similar to anesthesia used for a colonoscopy. It’s an incredible difference. On average, the length of stay for surgical valves is seven days, whereas the length of stay for the TAVR is two days.