Heart concerns: TAVR procedure option for lower risk patients

Posted: June 15, 2022

According to the Society of Thoracic Surgeons (STS) in the U.S., nearly 300,000 transcatheter aortic valve replacements (TAVR) have been performed since 2011, when the Food and Drug Administration (FDA) first approved the TAVR device. [caption id="attachment_16653" align="alignright" width="450"] Use of the TAVR procedure is expected to grow as it becomes more commonly used in younger, lower-risk patients.[/caption] The number is expected to grow rapidly as the TAVR procedure is becoming more commonly used in younger, lower-risk patients. "There are more and more studies being done," said Nurse Practitioner Michelle Alikpala, structural heart coordinator at Marshfield Clinic Health System. "TAVR has been an unbelievable benefit to patients and it seems to only be growing."

What is TAVR?

TAVR is used when patients are suffering from a narrowing of the aortic valve opening (aortic stenosis) of the heart. Over the past decade, the procedure is commonly use for patients who are:

• 80 or older, or
• Have other medical conditions that makes them high-risk for open-heart surgery.

With TAVR, a catheter carries a new valve through the blood vessels into the narrowed aortic valve. The stent that houses the new valve then expands into place and the new valve starts working right away.

Benefits of the TAVR procedure

Alikpala says patients generally have low complication rates and are discharged from the hospital as early as the next day. Surgical aortic valve replacement (SAVR) typically is recommended for patients around age 65 due to long-term durability. A SAVR valve is a fixed stent with an approximate life span of 15 years. While the TAVR valve was thought to have less sustainability, studies have found it to be similar in durability. A NOTION study found TAVR durability to be about eight years after surgery. The Partner3 trial for low-risk patients found that one year after the procedure, the rate of death, stroke or re-hospitalization was significantly lower with TAVR than with surgery. TAVR procedures are less invasive than typical open-heart surgery. Recovery time is also quicker and complications fewer, which is why TAVRs are becoming more commonly used on younger patients. "That's the major thing, if you can help the heart resulting in similar or better result, why not go for TAVR?" Alikpala said. She recommends all patients with severe valvular heart disease have intervention and be evaluated by a multidisciplinary team.

Discuss with your provider

"I want to reiterate however, the importance of the multidisciplinary team discussion, because through that, we get to offer the optimal approach for the patient in their own unique circumstance," Alikpala said. Per FDA, Dr. Alikpala said people who are good candidates for TAVR include:

• Individuals age 65 or older, and
• Whose life expectancy is between 10-20 years.

"No case is ever similar. This is why the structural heart team discusses patients in so much detail, so we can recommend the best approach for every unique patient," Alikpala said.

Other considerations

Not everyone is suitable for TAVR. If patients have endocarditis (infection of the heart), aneurysms, and severe coronary artery disease or low coronary takeoffs – the surgical approach is then considered. The lifetime management of the aortic valve also needs to be well thought out, Alikpala said. It is becoming a more common thought in the medical field that TAVRs will be the go-to option for aortic stenosis. "Just 10 years ago patients who were too high-risk for open heart surgery really had no options," Alikpala said. "It already is being used in medical trials as to the benefit of using it in low-risk patients. TAVR has been an incredible advancement and with research being conducted right now, it's probably only going to be used more." Talk to your primary care provider or cardiologist to start the discussion if TAVR is an option for your heart health needs.