Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Transcatheter Aortic Valve Replacement

Overview

In a transcatheter aortic valve replacement (TAVR) procedure, we guide a synthetic valve to the heart using a very thin tube (catheter). TAVR has fewer risks and a quicker recovery time than open-heart surgery.

The aorta is the body’s largest blood vessel. It carries blood from the heart to the rest of the body. The aortic valve controls blood flow from the heart's lower left chamber (ventricle) into the aorta. The aortic valve:

  • Opens when the heart pumps, to let blood flow into the aorta.
  • Closes to prevent blood from flowing back into the heart.

If the aortic valve doesn’t work properly, blood can pool in the left ventricle. This can lead to:

  • Congestive heart failure
  • Blood clots 
  • Other health problems

Some of these conditions require aortic valve replacement to improve heart function.

Why It Is Done

If you need your aortic valve replaced, we may recommend a transcatheter aortic valve replacement (TAVR).

The 2 main types of aortic valve disorders are:

  • Aortic stenosis, which is narrowing of the aortic blood vessel. 
  • Aortic regurgitation, which occurs when the valve doesn’t close properly and blood "leaks back" into the heart. 

Medications can control these disorders for a while. Eventually the aortic valve must be replaced. The standard treatment is open-heart surgery. For patients who aren’t good candidates for standard treatment, TAVR is safer and more effective.

TAVR avoids risks related to open-heart surgery. Other advantages include:

  • Less trauma to the body.
  • Much shorter recovery period. 

Aortic stenosis and aortic regurgitation symptoms are relieved after TAVR. It improves your heart function right away and for the future.

Your cardiologist uses set guidelines to determine whether TAVR is appropriate for you. A special physician team performs the procedure.

Before Your Procedure

You’ll have tests to assess the condition of your heart and whether TAVR is right for you. These tests may include:

  • Blood tests 
  • Chest X-rays 
  • Electrocardiogram and echocardiogram 
  • Lung function tests 
  • Computed tomography (CT) scan or magnetic resonance imaging (MRI) of the chest 
  • Cardiac catheterization with coronary angiogram

Tell us if you take blood-thinning medication such as aspirin or warfarin (Coumadin). We may tell you to stop before the procedure.

Before we begin your procedure, we will:

  • Clean the skin at your incision site with special soap.
  • Give you either local anesthesia (you remain awake and pain-free) or general anesthesia (you remain asleep).
  • Place a catheter in your bladder to drain urine.

How It Is Performed

The 2 types of TAVR are transfemoral access procedure and transapical access procedure. TAVR takes 1 to 2 hours.

During a transfemoral access procedure, we follow these steps:

1. Make a small puncture in the skin to access the femoral artery, near the groin.

2. Insert a very narrow, flexible hollow tube (catheter) into the artery.

3. Use X-ray imaging to guide the catheter through the artery to the heart. 

4. Inflate a small balloon on the catheter’s tip to stretch the aortic valve open.

5. Deliver the new valve to the heart using a second catheter.

6. Deposit the new valve within the old, diseased valve.

7. Inflate the balloon on the second catheter to expand the new valve, which should begin working right away.

Then the catheters are removed. We repair the femoral artery puncture site and apply a bandage. We perform tests to make sure the heart is functioning properly.

During a transapical access procedure, we:

1. Make a small cut on the left side of your chest, so that the catheter can be inserted.

2. Insert the catheter directly onto the apex, or tip, of the heart. 

3. Place the catheter into the heart muscle and use X-ray imaging to guide it to the aortic valve.

The rest of the procedure is the same as the transfemoral access approach.

Pacing wire

To make the procedure safer and easier to perform, we sometimes use a special type of wire (pacing wire). It briefly speeds up the heart, which lowers blood pressure and reduces the heart's motion.

We insert a pacing wire through a vein in the groin and guide it to the heart. We send an electrical impulse through the wire for a few seconds. When the procedure is complete, we withdraw the wire.

Risks

When TAVR is compared to open-heart valve replacement surgery, the risk of:

  • Stroke is higher for 1 year after having TAVR. This may happen if the old aortic valve creates blood clots or bubbles. 
  • Major bleeding is lower.

Other possible risks include: 

  • Infection 
  • Internal bleeding 
  • Bruising at the puncture site
  • Allergic reaction to the anesthetic 
  • Injury to the femoral (access) artery
  • Heart attack  
  • Kidney failure 

After Your Procedure

You will be in the intensive care unit (ICU) for 24 to 72 hours (1 to 3 days) after your TAVR procedure. During your recovery time:

  • Tubes that help you breathe and provide fluids and medications may remain in place.
  • You may receive breathing exercises and therapy to lower your risk of lung infection.  
  • You may be given aspirin or other blood-thinning medication to prevent blood clots. We may instruct you to continue taking this medication after you return home.
  • We watch your recovery process carefully.

We may give you follow-up tests, including:

  • Chest X-ray 
  • Urinalysis 
  • Electrocardiogram and/or echocardiogram 
  • Blood tests 

You may only be able to drink liquids, such as soup, juice, or water, for a while after TAVR. We’ll advise you on when to start adding soft foods, such as applesauce or ice cream.

Follow-Up Care

We will let you know when to schedule follow-up visits. You’ll probably have additional tests, such as a chest X-ray or electrocardiogram, during these visits. 

After you return home, you can take a shower or bathe as soon as you’re comfortable doing so. Wash the area around the puncture site carefully. 

Please contact us right away if you have any of these symptoms: 

  • Bleeding, swelling, or draining at the incision site 
  • Fever or chills 
  • Difficulty breathing 
  • Dizziness or lightheadedness 
  • Uneven or rapid heart beat 
  • Chest pain, nausea, or excessive sweating 
Eating and exercise

Be sure to continue drinking 6 to 8 cups of liquid every day, even after you resume eating solid foods. Eat a variety of healthy foods and avoid too much salt and high-fat foods. We’ll talk with you about other eating changes, if needed, at your follow-up visits. 

Exercise can help you recover. Begin slowly and do a little at a time, at first. We’ll talk with you about exercise options. 

Related Health Tools:

Interactive Programs
Prepare for Your Procedure

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This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.