Having a Transcatheter Aortic Valve Replacement (TAVR)
Your healthcare provider recommends that you have a transcatheter aortic heart valve replacement (TAVR). This is a surgery to replace a diseased aortic valve with a new tissue or biological valve. TAVR is done by putting a thin, flexible tube called a catheter through a blood vessel in your groin, or through a small incision under the collarbone, or between your ribs. The catheter is used to deliver an artificial valve to your heart. The TAVR procedure has been recommended to you as an alternative to open heart surgery.
Be sure to talk with your healthcare provider about any questions or concerns you have before the surgery. The surgery takes 3 to 5 hours. You’ll remain in the hospital for 4 to 8 days. Here’s what to expect before, during, and after the procedure.
Before the procedure
Before the day of surgery, you will have a physical exam and tests. These tests include X-rays, CT scans, lung tests, and blood tests. You will have an echocardiogram to check your aortic valve. This is a test that uses sound waves to create images of your heart. You may also have a cardiac catheterization. This will tell your doctor more about your heart and how blood is flowing through your arteries and about the pressures inside your heart and lungs.
Before the surgery you will also need to:
Tell your healthcare provider about all medicines you take. This includes over-the-counter medicines, vitamins, herbs, and other supplements. It also includes any blood thinners, such as warfarin or daily aspirin. You may need to stop taking some or all of them before your surgery.
Tell your healthcare provider if you’re allergic to any medicines, have had a reaction to anesthesia, or have a bleeding disorder.
Stop smoking. Ask your healthcare provider how soon before surgery you need to quit.
Not eat or drink for a certain number of hours before the surgery. Your doctor will give you specific instructions.
Shower with special soap before the surgery if advised.
Follow all other instructions that you are given.
During the procedure
Even though the TAVR procedure uses a less invasive approach than traditional aortic valve replacement surgery, the procedure is generally carried out with general anesthesia in an operating room or specially equipped catheterization lab.
An intravenous (IV) line is put in your arm or hand. This supplies fluids and medicine. To keep you free of pain during the surgery, you are given general anesthesia. This puts you in a state like deep sleep through the procedure.
A catheter is placed into your bladder to drain urine.
A monitor called an arterial line is put into the artery in your wrist to monitor blood pressure and take blood samples.
A small probe is placed into your throat. This is to do echocardiograms during the procedure.
Antibiotics are given before the procedure to protect you from infection. You will also get antibiotics after the procedure.
A catheter is put in the femoral artery in the groin. It is then guided through the artery up into your heart and to your aortic valve. Other catheters, from the neck, wrist, or the other leg, are put in your heart to take measurements and X-ray pictures during the procedure.
The new valve is delivered through the catheter to the heart on a collapsed balloon.
When the balloon is in the right place in the aortic valve area, it is inflated. This puts the new valve in place.
Measurements and images are taken to make sure your new valve works properly. Then the catheters are removed.
The catheter in your leg is removed and your incision is closed.
If your groin artery is too small, your doctor may put the catheter through a cut under the collarbone or between your ribs instead.
After the procedure
You’ll be moved to the intensive care unit (ICU) to start your recovery. When you first wake up, you may feel groggy, thirsty, or cold. These feelings won’t last long. You will likely have some thin tubes in your body. These are to give you medicines and nutrition, and to measure your heart function. If you had the surgery done through your ribs, you may also have a drainage tube coming out of your chest. The tubes will be removed when they are no longer needed. Medical staff members will carefully watch you. You may have a breathing tube in your throat after the procedure. It is usually removed when you are able to wake up. When your condition is stable, you’ll be taken to your hospital room.
Your recovery will depend on how invasive your procedure is for your valve replacement. You will likely need to stay in the hospital for several days. You may even need to stay longer than a week. If you’ve had the surgery done through your ribs, you may spend more time in the hospital than if you had the surgery done through your groin. After you leave the ICU, you will go to a general cardiology area of the hospital to recover further. You’ll be encouraged to stand and walk, even if you feel tired. Walking helps your muscle strength, blood flow, and breathing. Your healthcare provider will let you know when you can go home. Have a family member or friend drive you home.
March 21, 2017
Repurposed from 135-79, Up To Date. Transcatheter Aortic Valve Replacement
Gandelman, Glenn, MD, MPH,Snyder, Mandy, APRN