The aortic valve is one of four valves that control blood flow in the heart. The aortic valve specifically controls the blood that runs from the heart through your aorta and to the rest of the body. Over time or because of a congenital heart defect, you can develop aortic stenosis—a type of heart valve disease—which is narrowing of the aortic valve. This narrowing blocks the flow of blood to your body and forces your heart to work harder. You may need TAVR to replace a diseased aortic valve or to repair a replacement aortic valve that no longer works. Your doctor may recommend TAVR if you have a medical condition that makes it too risky to replace the valve during open-heart surgery, which is more invasive.
Cardiologists, or doctors who specialize in the heart, typically perform TAVR in a hospital. Before TAVR, your medical team will measure the valve opening, then give you medicines that relax you or put you to sleep, as well as medicines that prevent abnormal blood clots. During the procedure, your doctor will guide a thin, flexible tube called a catheter to your heart through vessels that can be accessed from the groin or thigh, abdomen, chest, neck, or collar bone. Inside the catheter is a folded replacement valve, which your doctor will implant securely within the old valve. Once your doctor is sure the new valve has been placed correctly, he or she will check for leaks and possible complications, such as a problem in the heart’s electrical signaling.
After a TAVR procedure, your hospital stay may be shorter and you may be able to return to daily activities, such as exercising and driving, sooner than with open-heart surgery. However, TAVR carries some risks, including stroke, damage and bleeding where the catheters were inserted; need for permanent pacemaker due to damage to the heart’s electrical signaling during the procedure; and injury to the kidneys or the heart. Sometimes the new valve leaks because it does not fit well. Your doctor may give you medicine to prevent infection or abnormal blood clots. About a month after the procedure, your doctor will test to check how well the valve is working and how well you are healing. You may need follow-up visits every year to make sure the valve continues working as it should.
There are several ways your doctor can perform TAVR, depending on your health and the condition of your blood vessels. Your doctor usually guides a tube with the replacement valve through a blood vessel in your groin or thigh, called the femoral artery.
If your femoral artery is too small or damaged by disease, your doctor may guide the tube through vessels that can be accessed from the chest. This approach is called transapical access. Your doctor may cut into your chest through your breastbone or ribs to access the heart directly through the aorta or through the pointed end of the heart, called the apex.
Less commonly, your doctor may guide the tube through vessels accessed from the abdomen, neck, or collar bone.
Your doctor may also use additional techniques to help prevent complications. New approaches to doing TAVR are making the procedure available to more patients.
In some patients, a replacement valve can push aside an old valve flap, blocking blood flow to the heart. The result—coronary artery obstruction—is a rare but life-threatening complication of TAVR, and NHLBI researchers have invented a technique to prevent it. Called Bioprosthetic Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction (BASILICA), the procedure involves using an electrified wire inside a catheter to cut the existing valve flap before placing the new valve. Without this technique, replacing a faulty valve would be too risky for these patients. Learn more about NHLBI's TAVR research.
Learn about the following ways the NHLBI continues to translate current research into improved health for people who have heart valve diseases. Research on this topic is part of the NHLBI’s broader commitment to advancing heart and vascular disease scientific discovery.
In support of our mission, we are committed to advancing heart valve diseases research in part through the following ways.
Learn more about exciting research areas the NHLBI is exploring.
We lead or sponsor many studies aimed at preventing, diagnosing, and treating heart, lung, blood, and sleep disorders.
After reading our TAVR Health Topic, you may be interested in additional information found in the following resources.