Questions and Answers about Minimally Invasive Aortic Valve Replacement
Who Determines If I Am a Candidate for Aortic Valve Surgery or TAVR?
Our highly dedicated heart valve center team will fully evaluate your condition to determine the best course of treatment. The team includes cardiothoracic surgeons and interventional cardiologists who are experts in both procedures.
What screening tests will I have to undergo during the evaluation?
These are the following tests you will need to take:
Echocardiogram: An echocardiogram is a test that relies on sound waves to create pictures of the heart and blood flow through the heart. The picture is more detailed than a standard x-ray image.
CT Angiography of the Chest, Abdomen, and Pelvis: Computerized tomographic angiography or CT Angiography (CTA) is a test that uses a conventional CT scan to create detailed images of the blood vessels in the body. The test involves the intravenous injection of a contrast dye to visualize blood flow within the vessels.
Pulmonary Function Test: Pulmonary function tests are a group of tests that measure how well the lungs take in and breathe out air and how well they move gases such as oxygen from the atmosphere into the blood stream. During the test, you breathe into a mouthpiece that is connected to an instrument called a spirometer. The spirometer records the amount and the rate of air flow as you breathe in and out over a period of time.
Who Performs the TAVR Procedure?
TAVR is performed by an interventional cardiologist and a cardiothoracic surgeon working side by side. At St. Francis Hospital, the majority of TAVR procedures are performed by Dr. Petrossian and Dr. Robinson, who are both pioneers in the procedure. In addition, we have a team of top rated physicians who are experts in the technique. You may also meet with them throughout the evaluation and testing process, and for follow-up care.
Should I Stop Taking Medications Before My Procedure?
If you are taking Coumadin (warfarin sodium) for atrial fibrillation, you would need to stop the medication five days before the procedure. Depending on the reason you take Coumadin, it may be necessary for you to take either Lovenox injections on an outpatient basis, or to be admitted to the hospital for Heparin crossover while the Coumadin affect wears off. If you are taking Pradaxa (dabigatran etexilate mesylate) for atrial fibrillation, you will likely have to stop taking the medication one to two days prior to your procedure. Surgical candidates (including those patients in the clinical trial who might be randomized to surgery) should stop taking Plavix seven days prior to their procedure. Our clinical team will provide you with full medication instructions once your procedure is scheduled. You should never stop any of your medications without consulting our clinical team.
Are There Medications I Need to Take After the TAVR Procedure?
If you are not currently taking a blood-thinning medication, such as Coumadin (warfarin sodium) or Pradaxa (dabigatran etexilate mesylate), after the TAVR procedure you likely will be prescribed aspirin and Plavix (clopidogrel bisulfate) for stroke prevention. Our clinical team will prescribe the appropriate doses before you are discharged from the hospital. You will need to take prophylactic antibiotics any time you have a dental procedure other than a standard teeth cleaning. You are encouraged to contact our office in the event that you require an invasive dental procedure, so that we can inform your dentist of the appropriate preventive measures.
What Type of Anesthesia Is Required?
General anesthesia or moderate sedation anesthesia will be used during the TAVR procedure (with a few exceptions) and general anesthesia during open-heart surgery. Anesthesia time is approximately 2 hours for a TAVR procedure and 4 to 5 hours for open heart surgery.
If I Already Have a Tissue Valve, Can I Still Have TAVR?
Yes. Tissue heart valves may degenerate over time and can eventually fail. A new technique is currently in clinical trials called “valve-in-valve” where the transcatheter aortic valve is implanted tightly into the failed valve, pushing the old valve leaflets aside. We have successfully performed quite a few of these procedures. Open-heart surgery may also be a viable treatment option.
How Long Have You Been Doing TAVR?
St. Francis was one of the first sites in the U.S. to be activated for the Medtronic CoreValve Pivotal Trial in December of 2010 and is one of the highest volume sites in the U.S. Our physicians have performed hundreds of TAVR procedures on some of the most medically complicated patients with excellent success rates.
What Are the Major Risks Associated with TAVR?
Recent studies show that patients who were at high risk for surgery and underwent a TAVR procedure had similar outcomes to surgical patients. However, TAVR patients do have a slightly higher risk of stroke compared to patients who have open-heart surgery. Those who have open-heart surgery have almost double the risk of bleeding complications as compared to TAVR. Therefore, the overall risk and mortality rate is very similar in both procedures.
How Long Will I Be In the Hospital?
Recovery rates can vary from patient to patient depending on the severity of a patient’s condition. But evidence shows that those who are motivated to recover tend to recover more quickly and spend fewer days in the hospital.
Patients who have either mitral or aortic valve open-heart surgery can expect to remain in the hospital, on average, for 5 to 10 days following the procedure.
TAVR patients can expect their length of stay to be between 3 to 5 days for transfemeroral access, 4 to 7 days for a transaortic approach, and 5 to 10 days for a transapical procedure.
Patients who have mitral or aortic valve open-heart surgery can expect to be in the ICU for approximately 48 hours; those who have a transfemoral TAVR will be in the ICU for 24 hours.