Transcatheter Valve Therapy (TAVR)
The Heart and Its Valves
A healthy heart, which beats about 100,000 times a day, supplies the body with oxygen-rich blood. The heart is a muscular organ that has four chambers. Blood is pumped through the four chambers with the help of four heart valve – the aortic valve, the pulmonic valve, the mitral valve and the tricuspid valve. During an average lifetime, these valves will open and close over two billion times.
Heart valves open when the heart pumps to allow blood to flow. They close quickly between heartbeats to make sure the blood does not flow backward. Any trouble with this normal flow makes it hard for the heart to pump the blood where it needs to go.
The aortic valve controls the flow of blood as it exits the heart and is pumped to the rest of the body.
Currently, no medicines can cure heart valve disease. However, lifestyle changes and medicines often can treat symptoms successfully and delay problems for many years. Eventually, though, you may need surgery to repair or replace a faulty heart valve.
The goals of treating heart valve disease might include:
- Repairing or replacing faulty valves
- Heart-healthy lifestyle changes to treat other related heart conditions
In addition to heart-healthy lifestyle changes, your doctor may prescribe medicines to:
- Lower high blood pressure or high blood cholesterol.
- Prevent arrhythmias (irregular heartbeats).
- Thin the blood and prevent clots (if you have a man-made replacement valve). Doctors also prescribe these medicines for mitral stenosis or other valve defects that raise the risk of blood clots.
- Treat coronary heart disease. Medicines for coronary heart disease can reduce your heart’s workload and relieve symptoms.
- Treat heart failure. Heart failure medicines widen blood vessels and rid the body of excess fluid.
Repairing or Replacing Heart Valves
Your doctor may recommend repairing or replacing your heart valve(s), even if your heart valve disease isn’t causing symptoms. Repairing or replacing a valve can prevent lasting damage to your heart and sudden death.
The decision to repair or replace heart valves depends on many factors, including:
- The severity of your valve disease
- Whether you need heart surgery for other conditions, such as bypass surgery to treat coronary heart disease. Bypass surgery and valve surgery can be performed at the same time.
- Your age and general health
When possible, heart valve repair is preferred over heart valve replacement. Valve repair preserves the strength and function of the heart muscle. People who have valve repair also have a lower risk of infective endocarditis after the surgery, and they don’t need to take blood-thinning medicines for the rest of their lives.
However, heart valve repair surgery is harder to do than valve replacement. Also, not all valves can be repaired. Mitral valves often can be repaired. Aortic and pulmonary valves often have to be replaced.
Repairing Heart Valves
Heart surgeons can repair heart valves by:
- Adding tissue to patch holes or tears or to increase the support at the base of the valve
- Removing or reshaping tissue so the valve can close tighter
- Separating fused valve flaps
Sometimes cardiologists repair heart valves using cardiac catheterization. Although catheter procedures are less invasive than surgery, they may not work as well for some patients. Work with your doctor to decide whether repair is appropriate. If so, your doctor can advise you on the best procedure.
Heart valves that cannot open fully (stenosis) can be repaired with surgery or with a less invasive catheter procedure called balloon valvuloplasty. This procedure also is called balloon valvotomy.
During the procedure, a catheter (thin tube) with a balloon at its tip is threaded through a blood vessel to the faulty valve in your heart. The balloon is inflated to help widen the opening of the valve. Your doctor then deflates the balloon and removes both it and the tube. You’re awake during the procedure, which usually requires an overnight stay in a hospital.
Balloon valvuloplasty relieves many symptoms of heart valve disease, but may not cure it. The condition can worsen over time. You still may need medicines to treat symptoms or surgery to repair or replace the faulty valve. Balloon valvuloplasty has a shorter recovery time than surgery. The procedure may work as well as surgery for some patients who have mitral valve stenosis. For these people, balloon valvuloplasty often is preferred over surgical repair or replacement.
Balloon valvuloplasty doesn’t work as well as surgery for adults who have aortic valve stenosis. Doctors often use balloon valvuloplasty to repair valve stenosis in infants and children.
Replacing Heart Valves
Sometimes heart valves can’t be repaired and must be replaced. This surgery involves removing the faulty valve and replacing it with a man-made or biological valve.
Biological valves are made from pig, cow, or human heart tissue and may have man-made parts as well. These valves are specially treated, so you won’t need medicines to stop your body from rejecting the valve.
Man-made valves last longer than biological valves and usually don’t have to be replaced. Biological valves usually have to be replaced after about 10 years, although newer ones may last 15 years or longer. Unlike biological valves, however, man-made valves require you to take blood-thinning medicines for the rest of your life. These medicines prevent blood clots from forming on the valve. Blood clots can cause a heart attack or stroke. Man-made valves also raise your risk of infective endocarditis.
You and your doctor will decide together whether you should have a man-made or biological replacement valve.
If you’re a woman of childbearing age or if you’re athletic, you may prefer a biological valve so you don’t have to take blood-thinning medicines. If you’re elderly, you also may prefer a biological valve, as it will likely last for the rest of your life.
Transcatheter Valve Therapy
Interventional cardiologists perform procedures that involve threading clips or other devices to repair faulty heart valves using a catheter (tube) inserted through a large blood vessel. The clips or devices are used to reshape the valves and stop the backflow of blood. People who receive these clips recover more easily than people who have surgery. However, the clips may not treat backflow as well as surgery.
Doctors also may use a catheter to replace faulty aortic valves. This procedure is called transcatheter aortic valve replacement (TAVR). For this procedure, the catheter usually is inserted into an artery in the groin (upper thigh) and threaded to the heart. A deflated balloon with a folded replacement valve around it is at the end of the catheter.
Once the replacement valve is placed properly, the balloon is used to expand the new valve so it fits securely within the old valve. The balloon is then deflated, and the balloon and catheter are removed.
A replacement valve also can be inserted in an existing replacement valve that is failing. This is called a valve-in-valve procedure.
Source: National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services.