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Transcatheter Aortic Valve Replacement (TAVR)

Background

Severe symptomatic aortic stenosis carries a poor prognosis. Until relatively recently, surgical aortic valve replacement has been the standard of care in adults with severe symptomatic aortic stenosis. However, the risks associated with surgical aortic valve replacement are increased in elderly patients and those with concomitant severe systolic heart failure or coronary artery disease, as well as in patients with comorbidities such as cerebrovascular and peripheral arterial disease, chronic kidney disease, and chronic respiratory dysfunction.

Transcatheter aortic valve replacement (TAVR) was developed as an alternative to the surgical approach in this high-risk and inoperable population. TAVR is a minimally invasive, catheter-based procedure to replace the function of the aortic valve. Indicated for patients at intermediate or greater risk for open heart surgery, TAVR may be an excellent option for certain patients because the prevalence of aortic stenosis and comorbidities may increase the risks associated with surgical aortic valve replacement (SAVR). The entire procedure typically takes approximately 1-2 hours. A heart team comprising cardiac surgeons, interventional cardiologists, and other aortic stenosis experts may determine what the best procedure is as well as take into account other considerations such as whether the patient should receive a mild sedative or general anesthesia.

At the start of the procedure, surgeons make a small incision in one of three places, the groin, the neck, or an intercostal space. A thin, flexible catheter with the heart valve is guided through the incision into the artery and to the diseased valve. The TAVR heart valve is placed in the diseased or failing surgical valve; it begins working immediately. The catheter is then removed and the incision closed.

Currently available devices in the United States include the self-expandable Evolut R and Evolut PRO valves, the balloon-expandable Sapien3 and Sapien 3 Ultra valves, and the mechanically-expandable Lotus Edge valve.

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