Transcatheter Aortic Valve Replacement Surgery

Changing the face of treatment for patients with aortic stenosis

Doctors Medical Center has an experienced Valve Clinic, and we are proud to offer the Transcatheter Aortic Valve Replacement (TAVR) program to residents in the Central Valley. Our TAVR surgery team is composed of a multidisciplinary, collaborative group of physicians and caregivers, including interventional cardiologists, cardiothoracic surgeons, imaging specialists, anesthesiologists, advanced care nurses and valve clinic coordinators.

Our cohesive approach embodies optimal patient-centric care and collaborative treatment decisions. The team will conduct a comprehensive evaluation of patients with aortic stenosis to determine whether the TAVR procedure is appropriate and what treatment plans they recommend.

We accept most insurance and transfers from hospitals across the Central Valley and beyond. For referrals and more information about the TAVR program at Doctors Medical Center, please call 209-342-3311.

What is Aortic Stenosis?

Aortic stenosis (AS) is one of the most common and severe valve diseases. With AS, the opening of the aortic heart valve narrows. As a result, the heart needs to work harder and may not pump enough oxygen-rich blood to the body. Aortic stenosis can be caused by a birth defect, rheumatic fever, radiation therapy or can be related to age.

Approximately 2.5 million people in the United States over the age of 75 suffer from this disease. In elderly patients, aortic stenosis is sometimes caused by the buildup of calcium (mineral deposits) on the aortic valve’s leaflets. Over time, the leaflets become stiff, which reduces their ability to fully open and close. When the leaflets don’t fully open, a person’s heart must work harder to push blood through the aortic valve to the rest of the body. As a result, less oxygen-rich blood flows from the lungs to the brain and the rest of the body, which may cause symptoms.

Factors Associated with Aortic Valve Disease

• Aging
• High blood pressure
  
• High cholesterol
  
• Smoking

What are the Symptoms of Aortic Stenosis?

Patients commonly misunderstand the symptoms of AS as “normal” signs of aging. Common symptoms include:

• Fainting
  
• Breathlessness
• Chest pain, pressure or tightness
• A decline in activity level or reduced ability to do routine physical activities

Patients may live with aortic stenosis for many years during a latent, asymptomatic period, even before disease symptoms develop. However, after patients begin experiencing symptoms, they must receive treatment.

Without Treatment, Severe Symptomatic AS can be Life-Threatening.

After the onset of symptoms, patients with severe AS have a survival rate as low as 50% at two years and 20% at five years without aortic valve replacement. Traditional treatment for this disease is open-heart surgery, which may require extensive hospital stays and recovery times.

Some people may be diagnosed with severe, symptomatic AS and are at intermediate risk for open-heart surgery. Historically, such patients often refuse or are denied surgery. Transcatheter aortic valve replacement surgery may be a safer option.

What Is Transcatheter Aortic Valve Replacement Surgery?

Transcatheter aortic valve replacement surgery is a less invasive, catheter-based technique for replacing the diseased aortic valve. An interventional cardiologist and a cardiothoracic surgeon will work together in the TAVR procedure. They will guide a new valve into the heart through an incision in the leg while the heart is still beating, using guidance from X-ray and echocardiography.

The TAVR procedure can be performed through multiple access approaches. However, the most common approach is the transfemoral approach, in which the valve is delivered via a catheter through the femoral artery, as explained above. A minimally invasive approach uses a small incision in the chest to enter the tip of the left ventricle; this is also called the transapical approach.

What are the Benefits and Risks of Transcatheter Aortic Valve Replacement Surgery?

According to studies, a TAVR procedure may help your heart work better, extending the quality and length of life if you have severe aortic stenosis. It may also shorten your recovery time to getting back to everyday activities. Quality of life studies have shown patient health improvements within 30 days, including the ability to take care of themselves and participate in daily activities.

If intervention may be an option, the patient must be evaluated for any risks it may bring on. Factors such as the risk of operative mortality, patient frailty, significant organ system compromise, other major comorbidities and procedure-specific impediments must be considered. Like most surgeries, though there is a low chance of having one, there are risks when a patient undergoes a TAVR procedure, such as heart attack, stroke, bleeding, need for emergency surgery and potential damage to the electrical system of the heart.

How Long Will My Valve Last?

The length of your tissue valve depends on many patient factors and medical conditions. Regular follow-ups will help your doctors know how your valve is working.

Who Qualifies for TAVR Heart Surgery?

TAVR surgery can be performed in patients across all risk categories. However, this is not the only factor to consider. While TAVR surgery may sound good when you need your aortic valve replaced, it may not suit everyone. Our experienced heart team at Doctors Medical Center will be with you every step of your heart health journey. Our clinical cardiologist, interventional cardiologists, cardiac surgeons, and other heart specialists will evaluate and review all your relevant information and provide the best possible treatment option for you.

Who Should Not Have TAVR Heart Surgery?

The valve and delivery systems should not be performed in patients who cannot tolerate medications that thin the blood or prevent blood clots from forming and have an active infection in the heart or elsewhere.

What To Expect During The TAVR Procedure

TAVR heart surgery is usually performed by cardiologists or heart specialists in a hospital. Before surgery, they will give you relaxants or medications to put you to sleep. They will also give you medication to prevent severe blood clots.

What To Expect After The TAVR Procedure

The hospital stay after TAVR surgery may be a few days, and it may just take a few weeks for the patient to return to their daily activities (e.g., exercising, driving, etc.). After the procedure, patients will be given medications to prevent infection or abnormal clots. Expect follow-up visits to see how the valve works and how the patient is healing.

Patient Impact: TAVR Surgery Today

• Shorter hospital stay
• Minimally invasive procedure
• The survival rate of 30 days for patients at intermediate-risk of open-heart surgery who received this valve is 99%