 What is TAVR? TAVR is trans-cathediotic valve replacement. It's a new way of replacing the aortic valve, which is minimally invasive. It can be done through a small needle stick in the groin region, or it's done by other approaches as well. It's a way that we can replace your valve without opening your chest, without putting you on a bypass machine, and also to get you out of the hospital much quicker. What causes a hot valve to fail? And what are the traditional options for valve replacement? You're lucky. It's usually old age, the normal wear and tear on the heart. There are other causes that you may be born with that cause the hot valve to fail, but typically it's the calcium that builds up over time because the heart is beating and an average of 60 beats a minute. What are the advantages of TAVR over traditional valve replacements? The traditional way of replacing a valve is standard operation where they do a sternotomy, which means they open up your chest, they put the heart at rest, meaning they put you on bypass, and they remove the valve and sew in another valve. Since 2006, a new procedure has been performed, and there have been many modifications of it, where we are able to replace the valve minimally invasive. The advantages of TAVR over traditional surgery are truly the recovery time. You're in the hospital for two to four days after a trans-cathiotic valve replacement. You're up and walking within six hours of the trans-cathiotic valve replacement, and it is a minimally invasive procedure where we do not have to use the heart-mung machine to maintain your blood pressure during the operation. Who is a candidate for a TAVR? Candidates for trans-cathiotic valve replacement are patients who are considered too old, too sick or too frail to undergo standard aortic valve replacement. This may include patients in their 90s. This may include patients that have received previous radiation to their chest for the treatment of cancer. It could include patients that are on hemodialysis. Those are patients that are too old or very high risk for standard aortic valve replacement. But here at Winthrop University Hospital, we're part of many protocols that are looking at the less sick patient, the intermediate risk patient, the patients in their 70s that have one major comorbidity for a standard operation. So we are implanting valves in patients who are less sick now. How is the procedure performed and how long does it take? Well, there are three approaches, three major approaches. The first approach is similar to an angiogram or angioplasty, where we go through the groin artery. We put a catheter through a small needle stick up to the heart, and through that catheter we place the valve. And we make the heart beat very fast so that the valve won't move and we position it perfectly. The second approach is called the trans-aortic approach. We make a small incision in the sternum and go directly through the aorta, which is the major artery to the body directly into the heart. This is performed in patients whose arteries in their legs are too small and too heavily calcified that we cannot use the trans-femoral approach. The third approach is called the trans-apical approach. We make a small incision in the side of the chest and go directly through the tip of the heart and place the valve that way. Typically, the trans-femoral approach will take about 15 to 30 minutes to perform the entire procedure. The trans-aortic and the trans-apical approach will take a little bit longer and the recovery time will be a little longer in the hospital. What would my recovery be like? How does this compare to traditional valve replacement? Recovery after trans-catheter aortic valve replacement is typically quick. You're usually in the hospital for approximately two days. The first day you're in the ICU and you start walking in the ICU that day. The second day you're on the floor and the third day you're home. And you go home-home, not to a rehab facility. With the other approaches, the trans-aortic and the trans-apical, it's typically about four days in the hospital. How this compares to standard surgery in this age group and the patient population, you are typically in the hospital for about a week and being discharged to a rehab facility is not uncommon. What is stenosis and what are the symptoms? Aortic stenosis is a disease of the elderly. It happens with the wear and tear of the aortic valve. The heart is constantly beating. The aortic valve is constantly opening and closing and it gets beat up. It degenerates. It develops calcium on it. As it develops calcium, it narrows. When we're young and healthy, our valve area is about two centimeters squared, which is the same as a centimeter. It's two centimeters squared. As it decompensates and degenerates, it narrows down. Severe aortic stenosis is when the valve narrows down to about 0.7 centimeters squared. We call that critical aortic stenosis. At that level, we can develop symptoms. The three major symptoms that occur when we develop critical aortic stenosis are congestive heart failure, meaning you can get shorter breath on minimal exertion. You may have trouble breathing while laying flat. You may develop swelling of your ankles. You may just not feel well. You may not be able to walk as far as you used to walk about a month ago or two months ago. That's congestive heart failure. That's because blood is backing up into the lungs. The other major symptoms are chest pain or angina. You can get that on minimal exertion or at rest. The third major symptom is syncope. That is passing out and it can happen at any time, any place. And that is associated with sudden cardiac death as well. Why should someone have their valve replaced? The reason why do we replace the heart valve is that we know once you develop critical aortic stenosis, a valve area of less than 0.7 centimeters squared, and symptoms, we know that you have a one to two year mortality of 50%. Meaning 50% of people that have that are no longer with us at a year to two years. So we're replacing the valve to prolong your life and improve your lifestyle and the quality of your life. And that's the reason to replace the valve. Why should I go to Winthrop for my TAVR? Winthrop University Hospital has been performing transcathletic valve replacements since 2012. We were one of the first 50 hospitals in the United States to be approved for transcathletic valve replacement. The way we became approved is that we were very proficient in performing open heart surgery and standard aortic valve replacement. I think the experience begins when you first are evaluated. You meet our nursing coordinators who will walk you through the process. We have schedulers. You meet an open heart surgeon and the cardiologist at that time. And we make sure you're a candidate for transcathletic valve replacement. Then we have a conference to discuss how we're going to perform the procedure. And at this conference we discuss the sophisticated tests that we perform at Winthrop. This includes CT angiography as well as cardiac catheterization. Once all the workup is complete, we make a final decision what type of valve and how we're going to perform the procedure. And another reason to come to Winthrop University Hospital is that we are an extremely experienced center. We performed over 600 of these procedures in the last three and a half years. We ranked in the top 10 in the country at performing the procedure. I think it's a wonderful place to have this procedure performed.