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TAVR – Access Sites, Benefits, and Risks

A healthy, thriving heart is a sign of a well-functioning body. From managing the entire circulatory system to transporting nutrients and oxygen to different body parts, the human heart performs indispensable functions. Today, doctors offer less invasive procedures to perform corrective interventions on those with heart defects and other issues affecting the organ. Transcatheter aortic valve replacement is one such procedure that many choose. This article provides a detailed insight into this procedure:

TAVR – Access Sites, Benefits, and Risks

What is transcatheter aortic valve replacement?
Transcatheter aortic valve replacement (TAVR) is a procedure involving the replacement of the aortic valve in cases where it has narrowed considerably to the extent that it does not open up as it should. A catheter, or a flexible tube, is inserted into the chest and guided to the heart region. This catheter has a folded replacement valve, which is placed inside the original valve of the heart. Doctors recommend this procedure for those diagnosed with severe aortic stenosis, for whom an open aortic valve replacement procedure is highly risky.

Possible access sites
Through the femoral artery: The femoral artery is a blood vessel in the thigh or groin. Here, the surgeons guide a tube to the heart through the femoral artery.

Using the chest blood vessels: In some cases, the femoral artery may not be optimally functional or may be too small for the TAVR procedure. In such cases, doctors may implement a process called transapical access, where the chest blood vessels are used to guide the catheter to the heart.

Through the stomach blood vessels: The stomach blood vessels may be used to perform TAVR if the leg arteries are small or damaged. This process is called transcaval access. For this process, holes are created in the vena cava—two veins in the stomach—and the surrounding aorta so that the tube is first passed through the vein and then to the heart through the aorta. This is a less common method of performing TAVR.

Through a blood vessel under the clavicle: Sometimes, surgeons may insert the catheter through a blood vessel under the clavicle. This procedure is not used frequently and is typically implemented when other TAVR procedures do not work.

Through the septum: The septum is a tissue layer separating the heart’s left and right atria. In some cases, surgeons may perform TAVR by passing the catheter through this layer.

Benefits
Better blood flow: As the TAVR aims to widen a thin aortic valve, it significantly improves blood flow and circulation, enhancing the quality of life.

Relieves chest pain and breathlessness: A narrow aortic valve increases pressure in the left ventricle of the heart, making it thicker and leading to chest pain and shortness of breath, among other symptoms. TAVR resolves this condition by widening the aortic valve.

Fewer fainting spells: The increase in pressure in the left ventricle can cause lightheadedness and fainting, which become considerably infrequent after undergoing a TAVR procedure.

Risks
Bleeding: A sizable number of patients who have undergone TAVR experience bleeding following the procedure. For example, those with severe aortic stenosis are highly susceptible to spontaneous bleeding after the procedure, mostly owing to their age and comorbid conditions. It is best to discuss risks, benefits, and aftercare with a cardiologist beforehand to avoid surprises and choose the most suitable option. 

Stroke: Post-procedural stroke is among the most common complications of a TAVR and is particularly prevalent among older adults. Some of the proposed measures to manage this risk are intraprocedural pharmacological protection, generous use of anticoagulants after the procedure, and cerebral protection while performing TAVR. One should discuss with doctors the possibility of a post-procedural stroke and what measures they would be taking to lower this risk.

Atrial fibrillation: New-onset atrial fibrillation is another common complication of TAVR and may also lead to strokes among patients. Patients may require extensive post-operative care and longer stays at the hospital to recover in such cases.

Kidney disease: Some patients may face kidney diseases or related complications after TAVR. A heart surgeon can elaborate on such risks and the procedural and post-procedural care to prevent such complications.

Aftercare
It is important to exercise some caution right after a transcatheter aortic valve replacement surgery. For example, one should not drive for at least three days following the procedure. One should also avoid certain strenuous or high-intensity activities, such as cycling, lifting, high-intensity aerobics, and swimming until the doctor allows one to resume these activities. Activities that can strain the upper arm muscles or chest should also be avoided.

The TAVR is gaining increasing popularity due to its non-invasive technique of remedying the narrowing of the aortic valve. As it is not an open-heart surgery, it requires only a small incision on the skin. The entire procedure can be completed within 2 to 4 hours; however, one must be provided with adequate post-procedure care to check for any complications and ensure a speedy recovery.

Disclaimer:
The content of the articles discussing symptoms, treatments, health conditions, and side effects is solely intended for informational purposes. It is imperative that readers do not interpret the information provided on the website as professional advice. Readers are requested to use their discretion and refrain from treating the suggestions or opinions provided by the writers and editors as medical advice. It is important to seek the help of licensed and expert healthcare professionals when necessary.
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