Transcatheter Aortic Valve Replacement

The New Gold Standard for Aortic Valve Replacement in Elderly Patients

Due to the thickening of the valve leaflets; valve opening is impaired leading to decreased blood flow across the aortic valve. This imposes a greater workload on the heart leading to the symptoms of aortic stenosis.

Aortic stenosis is diagnosed in patients who present with one of the following symptoms like dyspnea (difficulty in breathing), angina (chest pain) or syncope (fainting episode).

When such patients are evaluated there may be clinical signs like a heart murmur on clinical examination.

The final definitive diagnosis is made on echocardiography – it reveals the degree of aortic valve narrowing and helps in decision making regarding management.

Therapy is based on the degree of aortic stenosis and the feasibility of various treatment approaches.

Medical management and follow up is indicated for patients with a mild degree of aortic stenosis. This is by routine follow up clinic visits and echocardiograms at these visits.

Patients with symptomatic or a severe degree of aortic stenosis are recommended aortic valve replacement.Patients who are symptomatic from severe aortic stenosis have a 50 % probability of survival at 2 years.Surgical aortic valve replacement is performed using either a conventional sternotomy or one of the minimally invasive approaches.


The New Gold Standard for Aortic Valve Replacement in Elderly Patients

  • Who are too frail to undergo open heart surgery
  • Have multiple co-morbid conditions rendering open heart surgery extremely high rish
  • Have had a previous heart surgery
  • Have had a previous aortic valve replacement (biologic/ bioprosthetic) and the valve is failing
  • Whose heart function is significantly depressed to withstands open heart surgery

Five-Year Outcomes For High-Risk Sapien Patients Demonstrate Equivalence To Surgery, Durable Valve PerformanceTransforming Aortic Valve Replacement Therapy



Transcatheter aortic valve replacement (TAVR) with the Edwards SAPIEN 3 valve demonstrated 75% lower rates of 30-day all-cause mortality and disabling stroke compared to surgery in intermediate-risk patients.

TAVR (Transcatheter Aortic Valve Replacement) or TAVI (Transcatheter Aortic Valve Implantation) is a minimally invasive catheter based procedure for aortic valve replacement.

The most commonly utilized approach is via a small incision in the groin to access the artery in the leg (transfemoral). There exist other approaches – the best approach is decided by the people who make up the Heart Team that is dedicated to the management of such patients.

Whichever approach is finally used the technique remains the same. A catheter is inserted across the diseased aortic valve and it is opened – pushing the calcified leaflets to the side. A new valve is then guided over a wire and seated in place of the old valve using the calcified leaflets as a scaffold.

The procedure can be performed under sedation in centers with expertise in this particular technique. This is in contradistinction to surgical aortic valve replacement where the patient is put under anesthesia and the heart is stopped to remove the old valve and replace it.

  • Therapy for cardiac disease is changing.
  • In order to secure best possible outcomes for patients the concept of a Heart Team has been adopted.
  • The Heart Team comprises cardiothoracic surgeons, cardiologists, cardiac anesthesiologists, radiologists, TAVR coordinators, dedicated cardiac care nurses, OR and cardiac cath lab staff who are well versed in the nuances of treatment of structural heart disease.
  • The entire team sits down and evaluates cases referred for TAVR on an individual basis. If you are intermediate or high risk for surgical aortic valve replacement you might be a candidate for TAVR based on the recommendations of the Heart Team.
  • Patients considered for TAVR are subjected to further testing to decide the mode of intervention in each individual patient.
  • These tests may include an ECG, Chest X-ray, Transthoraic echocardiogram (TTE), blood tests, Pulmonary Function Tests (PFT) and a Computerised Tomogram (CT). In addition a Coronary Angiogram (CAG) will be performed if initial testing is satisfactory.
  • Upon review of the investigative data a decision will be made on feasibility of TAVR and the best approach for the same.
  • In the majority of cases TAVR is performed using the Trans-Femoral (TF) approach via the vessels in the groin.
  • If the groin vessels are too small or badly diseased – the procedure may be performed via a small incision in the chest (Trans Apical) or in the upper part of the sternum (Trans Aortic). In the latter two approaches the patient would need a short period of general anesthesia.
  • As Per standard protocol discharge would be in 3-4 days following the procedure.