TAVR is a minimally invasive procedure for treating aortic stenosis in intermediate and high risk patients. With this procedure, patients are likely to experience an easier recovery with less pain and a shorter hospital stay than with traditional open heart surgery.
What aortic stenosis is, is that the aortic valve, or the door that connects the left ventricle of the main pumping chamber of the heart to the main blood vessel of the heart, called the aorta, does not open all of the way. And as a result, the heart begins to suffer.
So there really is only one treatment for aortic stenosis, and that’s aortic valve replacement therapy. We’re fortunate now to have several different ways to replace the valve, but in the end, the valve just needs to be replaced.
So aortic valve replacement therapy comes in two forms. One is traditional open heart surgery where their, the actual old heart valve is taken out and cut out and a new heart valve is sewn in its place. That can be done through big incisions that can be done through small incisions. And it works very well.
The only downside of traditional open heart surgery is that it’s invasive. And for many patients, some of whom just don’t want to go through open heart surgery, others who are not well enough to go through open heart surgery.
There, we have the second option now, and it’s become a relatively mature option over the last decade or so, and that’s transcatheter aortic valve replacement. We call it TAVR. TAVR is basically a way of getting a new valve inside of you without making a real incision.
What it means essentially is, the valve itself is loaded within a stent, and that stent is then inserted into your body. Most commonly, that’s inserted through one of the arteries in the leg. That valve then works its way up the artery, it’s loaded on a wire, and basically is positioned where your current diseased aortic valve is and the valve is just blown up.
When the valve is blown up or inflated, it pushes your old valve out of the way and now you have a new functioning valve in place of where the other one used to be.
Patients who have severe aortic stenosis can qualify for a TAVR in many different ways. There are commercial indications for transcatheter valve replacement. If patients have significant aortic stenosis and they have at least an intermediate or a high operative mortality risk. That means that their chances of dying with traditional open heart surgery are greater than 3%. Provided that they have the appropriate anatomy or that the heart is of the appropriate dimensions and positions that would allow for a valve to sit well.
Probably the thing I’m most proud of here at Washington University School of Medicine and Barnes-Jewish Hospital when it comes to our transcatheter valve program, is the way we evaluate patients. Patients who are sent to us for consideration of aortic valve replacement therapy get to be seen not only by a surgeon, but also with a cardiologist.
So a patient will come to our institution, they’ll have their testing done, we’ll review their testing together, we’ll walk into the room together. We’ll make, we’ll ask questions of the patients together. And then we’ll make a treatment decision for them together.
Some patients are fantastic candidates for transcatheter valve replacement, and that’s absolutely the direction they could go, they should go in. Others are not good candidates for transcatheter valve replacement and they may need open heart surgery.
Our transcatheter aortic valve replacement program at Washington University School of Medicine and Barnes-Jewish Hospital Heart and Vascular Center is pretty unique. We have the largest volume in the area, which allows us to have access to both commercially approved devices, and also participating clinical trials evaluating new technology that improves on the currently commercially available devices.
As a result, when patients get evaluated for a TAVR procedure at our institution, we’re able to select the right prosthesis for the right patient depending on the patient’s anatomy and other characteristics that would allow us to have a very successful result.