TAVR (Transcatheter Aortic Valve Replacement) | Tufts Medical Center

TAVR or transcatheter aortic valve replacement is an incredible leap forward for patients who have aortic stenosis as another treatment option for them. So the typical patient that is referred to us for TAVR will be an elderly patient over the age of 70, let’s say. Certainly we see patients with aortic stenosis who are younger than that who have different reasons for having a blocked aortic valve. The aortic valve is the valve that leads away from the left ventricle which is the body’s main pumping chamber. It is the chamber of the heart that allows blood to be delivered to the body for all the needs that the body has. So usually over time in the elderly in patients that have aortic stenosis, the valve calcifies. Calcium builds up and the valve is no longer able to open. The opening is restricted in such a way that it becomes tighter and tighter and tighter so that over time there’s a narrowing of this valve, such that patients become symptomatic primarily those symptoms are shortness of breath, chest pain, fatigue and fainting or feeling the need to faint. Once we made a diagnosis that is the autograph stenosis or narrowing the best treatment for that patient essentially is replacing the valve. There’s no other area the option. After 2011 TAVVR or trans catheter heart value was approved which actually allows us to deliver a new heart valve through a catheter through a minimally invasive incision. The gold standard still is surgical aortic valve replacement in which a cardiac surgeon will open the chest, put the heart on standby on a machine. The act of putting a patient on the cardiopulmonarybypass machine is one of the very important attributes of open-heart surgery, though it’s also a very invasive part of open-heart surgery. Transcatheter heart valve replacement does not need cardiopulmonary bypass in order for us to do the procedure. This is a less invasive procedure, in which we deliver a new heart valve while the heart is beating. So who’s a candidate for transcatheter heart valve in 2017? There’s been a rapid expansion over the last five or six years. Currently, transcatheter heart valve is approved for three different types of patients. The first group are patients that have exceptional risk for surgial aortic valve replacement. The second group are patients who are felt to be high risk for surgical aortic valve replacement by the TAVR team and then the third group are patients who are felt to be intermediate risk for surgical aortic valve replacement. All this has happened pretty quickly and about you know five or six years. We see now that transcatheter heart valve is as good as surgery in many different types of patients, and it well might be in the next two to three years we’ll see even a greater expansion of transcatheter heart valve to even lower risk patients. When you initially come in for your consultation, you’ll meet with various members of the TAVR team at some point you will meet with Everyone along with the evaluation phase. you may meet with an interventional cardiologist, the valve specialists, the cardiac surgeon and the nurse practitioner One of the most important parts of our evaluation phase is the team meeting with the patient and their family members. It’s very important that we remain connected with your primary care doctor in your cardiologist as well as any other as well as any other specialists that may be a part of your care team. The benefit to having all these members on the TAVR team is we have a true interdisciplinary approach to looking at each patient. The TAVR procedure currently takes place in the hybrid OR so this is a very specialized environment. It’s a cardiac catheterization laboratory and an operating room all in one so it has state-of-the-art imaging equipment and hemodynamic equipment that allows us to measure pressures as well as being a state-of-the-art fully functional operating room. So that we’re able to combine the skills of interventional cardiologists and cardiac surgeons both of whom are working in an environment that they are very comfortable in. Once we find out that the patient is candidate for and transcatheter aortic valve replacement they go through the process to find out which approach we can take under that patient. 80% of the patients candidate through the artery in the groin to get the valve a place in their aorta and this is called trans femoral approach however about 20% of the patients are not candidate for it next step is going through the valve through the small artery under the collar bone. The third way that we can get and place the valve is through a small incision in front of the chest a parasternal and the valve is placed through the aorta directly. When a patient is prepared for transcatheter heart valve they’ll arrive the day of their procedure to our preoperative area The procedure generally lasts for about two hours and during that time, we take care of every important step that includes the valve deployment and any other medical issue that needs to be dealt with during that operation. At the completion of the procedure at two hours, the patient is then transferred back either to the post anesthesia care unit for recovery for about four hours and then from the post anesthesia care unit, will then go to our specialized cardiac floor where they’ll recover further. Recovery for most of our patients is about two days after the operation and most are discharged to home. After a patient goes home for transcatheter heart valve, we typically see patients recovering and getting back to their standard functional capacity in about two to three weeks. Developing our transcatheter heart valve program or our TAVR program we’ve developed it understanding that it’s not a procedure, but a program. It is a team approach from the beginning in the procedure, a discharge and then after the recovery we feel truly fortunate at Tufts Medical Center to be able to offer this transformative Technology within our program we really pride ourselves on our compassion for our patients and their family But also keeping close attention to detail we care about each and every one of our patients as an individual And it’s very important to us that they feel comfortable with each step of the process

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