Transcatheter Valve Replacement

Transcatheter aortic valve replacement (TAVR), which is also called transcatheter aortic valve implantation (TAVI), is a minimally invasive approach to treat select patients with severe aortic stenosis, a condition where the aortic heart valve does not open wide enough to let adequate blood flow through.

When percutaneous aortic valve replacement is performed through the leg’s femoral artery, there are no major incisions involved and the heart is never stopped or put on bypass. A small incision is made in the leg, near the groin, and a catheter is threaded through a vein in the leg to the heart. Once it reaches the diseased valve, the catheter deploys a stent-type replacement valve which is ballooned open, pushing aside the old valve and immediately assuming function as the new valve.

Edwards SAPIEN transcatheter heart valve
Edwards SAPIEN transcatheter heart valve. Courtesy Edwards Lifesciences
inflated balloon catheter securing a replacement valve in the heart
Balloon catheter inflated to secure the replacement valve inside the diseased valve to improve blood flow from the left ventricle into the aorta.

An alternative valve replacement procedure is being studied that would insert the replacement valve through an incision in the ribs rather than the femoral artery in the leg. This option may require larger incisions, but it is still less invasive than bypass and could benefit patients with very small blood vessels.

The average recovery time for either approach is much shorter than for traditional surgical valve replacement, and patients report significantly less pain with the minimally-invasive approach. Candidates for percutaneous aortic valve replacement must have severe valve stenosis and be considered inoperable or at very high risk for surgical valve replacement.

The Washington University and Barnes-Jewish Heart & Vascular Center is the first and most experienced in the region to offer this procedure. A team of interventional cardiologists and cardiothoracic surgeons work together in an operating room which has both surgical and catheterization capabilities, and uses echocardiography and fluoroscopy to ensure the valve is optimally implanted in the patient’s heart.

Our Heart & Vascular Center is one of 23 heart centers (17 in the United States) that were selected to participate in the PARTNER trial (Placement of AoRTic traNscathetER valves), which led to the FDA’s approval of the transcatheter aortic valve replacement procedure on November 2, 2011.

Read Dyke Foster's Story

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