If you have been diagnosed with aortic valve stenosis, the condition may be managed with medication, but often surgery is needed to repair or replace damaged valves. Compared to traditional open heart surgery, the minimally invasive procedure, known as transcatheter aortic valve replacement (TAVR), has become a quicker and less invasive option for appropriate patients. Within the Heart & Vascular Center at Brigham and Women’s Hospital, the Structural Heart Disease Program is a destination for the TAVR procedure, with our team performing more TAVRs than any other hospital in New England.
1. The TAVR Procedure Replaces a Damaged Aortic Valve
TAVR is a minimally invasive procedure to replace the aortic valve of the heart for patients with severe aortic valve stenosis. It’s an alternative to traditional open heart surgery for appropriate patients.
2. TAVR Revolutionized the Treatment of Aortic Valve Stenosis
Aortic valve stenosis involves the narrowing of the aortic valve. This narrowing puts strain on the heart and can result in symptoms such as fatigue, shortness of breath and chest pain. If left untreated, aortic valve stenosis can lead to heart failure.
Aortic valve stenosis is common among the elderly. As patients get older, traditional heart surgery becomes riskier, and many elderly patients cannot safely undergo a standard aortic valve replacement. With the advent of transcatheter aortic valve replacement, which is much less invasive, many older patients can now have their aortic valve replaced safely.
3. TAVR May Soon Expand to More Patients
While TAVR has revolutionized the treatment of aortic valve stenosis—making it possible to treat many patients who would never have been considered for traditional open heart surgery—the less invasive procedure had traditionally been reserved for patients who are at high or intermediate risk for open heart surgery. Given the many benefits of TAVR, there has been a growing interest in making TAVR available to a broader array of patients, including low-risk patients.
A recent study in the New England Journal of Medicine showed that TAVR performed better than open-heart surgery in low-risk patients with severe aortic stenosis. The study found that one year after the procedure, the rate of death, stroke, or rehospitalization was significantly lower with TAVR than with surgery. The findings suggest that TAVR may be superior to surgery, even for patients with low operative risk.
Currently, Brigham and Women’s Hospital is one of two hospitals in New England participating in the PARTNER 3 Continued Access Trial that offers TAVR to low-risk patients undergoing valve replacement for severe aortic stenosis. The Brigham is also participating in the EARLY TAVR trial to assess whether aortic valve replacement and TAVR have equal benefits for patients who are younger, healthier and at low-risk for open heart surgery. More than 10 patients with asymptomatic severe aortic stenosis have already been enrolled in the EARLY TAVR trial.
4. A Multidisciplinary Team Performs TAVR in the Cardiac Catheterization Lab
The Structural Heart Disease Program offers the largest TAVR program in New England with the highest volume, in large part because TAVRs can be performed every day of the week. This high frequency maximizes access for patients, ensuring they don’t have to wait long for their procedure.
TAVRs are performed in the Brigham’s leading-edge Cardiac Catheterization Lab. More than 4,000 procedures are performed each year in the “cath lab,” including angioplasty, stenting procedures and TAVR. The cath lab offers a simpler and more flexible environment compared to traditional or hybrid operating rooms.
TAVRs are performed by a multidisciplinary team of cardiovascular specialists within the Structural Disease Program, including cardiac surgeons, interventional cardiologists, cardiac anesthesiologists, cardiologists, radiologists, and specialized nursing care. All of the TAVR team members work with patients and families to understand the benefits and potential risks associated with this minimally invasive procedure.
5. TAVR Offers a Faster Recovery Compared to Open Heart Surgery
A TAVR procedure takes about 90 minutes to complete, whereas open heart surgery typically takes 4-to-6 hours. With TAVR, patients recover faster than they would after a traditional open-heart valve replacement. The vast majority of patients who undergo TAVR are sedated, but not under general anesthesia. This “minimalist approach” allows for a less invasive procedure and a faster recovery, with many patients able to sit up and eat the same day.
The TAVR Program at the Brigham offers one of the shortest lengths of hospital stays, with one-third of patients going home the next day. Most patients are discharged within 48 hours, with instructions to avoid lifting anything heavy for a week.
6. Brigham’s TAVR Program is Growing Rapidly
In 2009, Brigham and Women’s performed its first TAVR as part of a landmark, multi-institutional series of clinical trials known as the PARTNER trials. Following approval by the FDA, the procedure moved into clinical service at Brigham and Women’s in 2011. Since TAVR went into commercial practice, the program has grown steadily. In 2018, the TAVR Program celebrated it’s the 1,000th case, making it the fastest to reach this milestone in New England.
7. TAVRs are Performed within 2-to-3 weeks of Initial Consultation
The TAVR Program runs three clinics per week for patient evaluations. Individuals are evaluated by a multidisciplinary team of cardiovascular specialists who specialize in the treatment of aortic valve disease.
Most patients receive all of their tests and imaging in a single day, minimizing the need to visit the hospital multiple times. A medical assessment determines whether you qualify for TAVR. If qualified, the procedure is typically performed within 2-to-3 weeks after an initial consultation.