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TAVR

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Transcatheter aortic valve replacement (TAVR) is a procedure to replace an aortic valve that is narrowed and doesn't open fully. Narrowing of the aortic valve is called aortic valve stenosis. The valve problem blocks or slows blood flow from the heart to the body.

 

TAVR is minimally invasive, which means it uses smaller incisions than open-heart valve surgery. TAVR can help reduce chest pain, shortness of breath and other symptoms of aortic valve stenosis. The decision to have TAVR is made after talking with a team of heart doctors and heart surgeons. The team works together to determine the best treatment option for you.

 

Transcatheter aortic valve replacement also may be called transcatheter aortic valve implantation (TAVI).

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Why it's done?

Transcatheter aortic valve replacement (TAVR) is a treatment for aortic valve stenosis. In this condition, the heart's aortic valve thickens and becomes stiff and narrow. As a result, the valve can't fully open and blood flow to the body is reduced. TAVR is an alternative to open-heart aortic valve replacement surgery. People who have TAVR often have a shorter hospital stay than those who have heart surgery to replace the aortic valve.

 

Your doctor may recommend TAVR if you have:

  • Severe aortic stenosis that causes symptoms such as chest pain and shortness of breath.

  • A biological tissue aortic valve that isn't working as well as it should.

  • Another health condition, such as lung or kidney disease, which makes open-heart valve replacement surgery too risky.

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Before the procedure.

A health care professional places an IV into your forearm or hand. Medicine called a sedative goes through the IV. The medicine helps you feel relaxed, calm or sleepy. Medicines to prevent blood clots and infection also may be given through the IV.

A member of your health care team may shave any hair from the area on your body where the procedure will take place.

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During the procedure.

During transcatheter aortic valve replacement (TAVR), a doctor replaces a damaged aortic valve with one made from cow or pig heart tissue. The cow or pig valve is called a biological tissue valve. Sometimes, doctors place a biological tissue valve into an existing one that no longer works.

TAVR uses small surgery cuts and a flexible, hollow tube called a catheter to reach the heart. It's different from open-heart surgery to replace the aortic valve. That surgery requires a long cut down the chest.

To do TAVR, a doctor inserts a catheter into a blood vessel, usually in the groin or chest area. The doctor guides the catheter to the location of the aortic valve in the heart using X-ray or other imaging tools as a guide.

The doctor sends a biologic tissue valve through the catheter and places it in the area of the aortic valve. A balloon on the catheter tip expands to press the new aortic valve into place. Some replacement valves expand without the use of a balloon.

The doctor removes the catheter once the new valve is securely in place.

During TAVR, your health care team carefully watches you. Your blood pressure, heart rate and rhythm, and breathing are constantly checked.

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After the procedure.

You may spend the night in a hospital's intensive care unit (ICU) so you can be carefully watched after your procedure. How long you stay in the hospital after TAVR depends on many things. Some people who have TAVRmight go home the next day.

Before you leave the hospital, your treatment team tells you how to care for any wounds and how to watch for symptoms of infection. Warning signs of infection include fever, increased pain and redness, swelling, draining or oozing at the catheter site.

Several medicines may be prescribed after TAVR, including:

  • Blood thinners, also called anticoagulants. This medicine helps prevent blood clots. Your health care team tells you how long you may need to take this medicine. Always take medicines as directed.

  • Antibiotics. These medicines treat and prevent bacterial infections. Germs can stick to or infect an artificial heart valve. Most bacteria that cause heart valve infections come from the bacteria in the mouth. Taking good care of your teeth and mouth can help prevent these infections. Get regular dental checkups. Antibiotics may be prescribed for use before certain dental procedures.

Regular doctor's checkups and imaging tests are needed after TAVR to make sure the new valve is working properly. Let your doctor know if you have any new or worsening symptoms, including:

  • Dizziness or light-headedness.

  • Swelling of the ankles.

  • Sudden weight gain.

  • Extreme tiredness with activity.

  • Swelling, redness, tenderness or other signs of infection at the catheter site.

Seek emergency medical help if you have:

  • Chest pain, pressure or tightness.

  • Severe, sudden shortness of breath.

  • Fainting.

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Results.

Transcatheter aortic valve replacement (TAVR) may reduce symptoms of aortic valve stenosis. Fewer symptoms may help improve quality of life.

Following a heart-healthy lifestyle is important as you recover from TAVR. Such lifestyle habits also can help prevent other heart problems. After TAVR:

  • Don't smoke.

  • Eat a heathy diet rich in fruits and veggies and low in salt and saturated and trans fats.

  • Get regular exercise — talk to your doctor before starting a new exercise routine.

  • Maintain a healthy weight. Ask your health care team what a healthy weight is for you.

Watchman Procedure

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The WATCHMAN™ is a small parachute-shaped device about the size of a quarter that prevents blood clots from forming in the left atrial appendage (LAA). The LAA is a small pouch that extends from the heart's upper left heart chamber (atrium).

People with atrial fibrillation (AFib), a type of irregular heart rhythm, have a high risk of blood pooling and forming clots in the LAA. Traditionally, blood thinners were the only treatment to prevent blood clots in patients with AFib. These medications can have challenging side effects, such as severe bruising or prolonged nosebleeds. The WATCHMAN closes the LAA to prevent clots from forming, without medication.

Who Might Be a Candidate for the Watchman Device?

People who have AFib that isn't caused by problems with their heart valves may be candidates for the WATCHMAN device. At Penn Medicine, our cardiologists offer the WATCHMAN device to most patients with AFib. This helps ensure our AFib patients experience even better outcomes with a lower risk of blood clots and stroke.

The WATCHMAN is especially beneficial for people who need to avoid taking blood thinners due to risk factors, such as high blood pressure (hypertension) or history of a stroke that increase the risk of severe bleeding. People who work very active jobs or have a higher risk of falling may have more risks associated with taking blood thinners.

 

Preparing for the Watchman Procedure

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Your care team will give you specific instructions to prepare for the WATCHMAN procedure. Most people don't need to do anything special. You may need to stop taking certain medicines, such as blood thinners, for a brief period. It's important to give your provider a full list of all medications, including over-the-counter medicines and herbal supplements.

The care team will likely instruct you to stop eating or drinking by midnight on the day of the procedure. Because the procedure uses anesthesia, you'll need to arrange for someone to drive you home.

 

What to Expect During the Watchman Procedure

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The WATCHMAN procedure usually takes about an hour. You receive anesthesia to keep you comfortable during the procedure. An interventional cardiologist, electrophysiologist, interventional echocardiographer and an anesthesia specialist work together to perform the procedure.

During WATCHMAN device placement, a physician:

  1. Makes a small incision in your groin and inserts a catheter through a blood vessel

  2. Uses imaging to guide the catheter through the vein to your heart

  3. Places the WATCHMAN device in the left atrial appendage

  4. Removes the catheter and closes the insertion site

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Watchman Procedure Recovery

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You usually stay in the hospital overnight after the WATCHMAN procedure. You may need to lie flat to prevent bleeding at the catheter insertion site. Your care team monitors you for any signs of complications.

After returning home, most people can resume their usual activities within 24 to 48 hours. Your cardiologist will likely advise that you avoid strenuous activity for at least one week.

It's normal to have some mild pain and bruising around the catheter insertion site for a few days. Call your doctor if you start experiencing any symptoms of complications, such as:

  • Bleeding, temperature changes or swelling around the catheter insertion site

  • Chest pain or pressure

  • Dizziness or fainting

  • Excessive sweating

  • Fever or chills

  • Nausea or vomiting

You continue taking your prescribed blood thinner and aspirin for several weeks after the procedure. Most people can stop taking prescription blood thinners around six weeks after WATCHMAN device placement. You may take daily aspirin for six months or longer.

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Benefits and Risks of the Watchman Device

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Studies show that the WATCHMAN device is as effective at preventing blood clots from forming in the left atrial appendage as blood-thinning medications. People who have the WATCHMAN device don't need to receive regular blood tests or avoid certain foods the way that they do when they are taking blood thinners.

The WATCHMAN procedure is minimally invasive, meaning the chest is not opened to access the heart. By avoiding open-heart surgery, this procedure offers people a faster recovery with less pain and fewer complications. People receiving a WATCHMAN also typically spend less time in the hospital compared to people who have open-heart surgery.

The risks of the WATCHMAN device are low, especially when the procedure is performed by a skilled interventional cardiologist. Rare risks of the WATCHMAN procedure include:

  • Blood clots

  • Infection

  • Pericardial effusion, a buildup of fluid in the membranes around your heart

  • Stroke

What is MitralClip?

MitraClip is a small device used to stop leaking in the mitral valve. It is placed on your mitral valve in a minimally invasive interventional cardiology procedure called transcatheter edge-to-edge repair (TEER) using a flexible, hollow tube (catheter). Penn interventional cardiologists offer both MitraClip and PASCAL, the two devices approved by the U.S. Food and Drug Administration (FDA) for mitral TEER.

The mitral valve controls blood flow between the lower left heart chamber (ventricle) and the upper left heart chamber (atria). In mitral valve regurgitation, the mitral valve doesn't close properly, causing leaking. This leaking means your heart has to work harder to pump blood through the body, which can cause atrial fibrillation (AFib) or heart failure.

As blood flows through your mitral valve, your mitral valve flaps open and close to allow for blood flow. The MitraClip helps to pull your mitral valve flaps into better alignment so that they open and close more effectively.

Your cardiologist may recommend MitraClip if you have severe regurgitation but aren't a good candidate for mitral valve repair and replacement surgery. Older people and those with underlying health conditions may be better candidates for MitraClip than they are for surgical procedures.

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Benefits of MitraClip

Because there is no large chest incision, MitraClip procedures offer significant benefits over open-heart surgery for mitral valve disease. Patients typically recover more quickly, spending less time in the hospital and experiencing fewer complications. Our patients also report less pain following catheter-based procedures.

MitraClip also offers immediate symptom improvement. People find that their shortness of breath, palpitations and fatigue are lessened right after surgery. Feeling better helps you get back to your usual activities more quickly.

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How to prepare for a MitralClip procedure?

Your care team gives you specific instructions to prepare for the MitraClip procedure. You may need to stop taking certain medicines for a brief period before the treatment.

You will likely also have several tests to evaluate your heart's structure and function and help your interventional cardiology team plan the MitraClip procedure, including:

  • Chest X-ray to look at your heart's structure

  • Doppler ultrasound to assess how blood flows through your heart

  • Echocardiogram to look at your heart's anatomy and blood flow

  • Electrocardiogram to check your heart rhythm

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What to expect during the MitralClip procedure.

MitraClip is placed during an inpatient procedure in the cardiac catheterization lab. The entire procedure takes two to three hours. You receive anesthesia to keep you comfortable. An entire team, including an interventional cardiologist, an interventional echocardiographer and an anesthesia specialist work together in this procedure.

When it's time for the procedure, the team connects you to an electrocardiogram machine that monitors your heart's electrical activity. You also are connected to machines that record your heart rate, breathing, oxygen levels and blood pressure.

During a mitral valve clip procedure, an interventional cardiologist:

  1. Makes a small incision in your groin to access your femoral vein, a large blood vessel that helps move blood to your heart

  2. Inserts a catheter through the incision

  3. Guides the catheter through the vein up to your heart with X-ray and echocardiography assistance

  4. Uses a small tool at the tip of the catheter to make a tiny hole in the wall that divides your heart chambers

  5. Positions the catheter near your mitral valve

  6. Inserts the clip through the catheter and places it at the edges of your mitral valve to prevent leaking

When the clip is in place, the interventional cardiologist removes the catheter and closes the small incision in your groin.

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MitralClip Recovery.

Most people feel immediate symptom improvement after a MitraClip procedure. You'll spend one to two days in the hospital where our cardiac team closely monitors you.

Your cardiologist gives you specific instructions for continued recovery at home. You may need to take aspirin or other medications to prevent a heart attack or stroke.

Our team evaluates your heart valve one month after surgery to ensure the clip is working properly. Annual visits to your cardiologist help to ensure the clip continues to work long-term.

After the MitraClip procedure, your provider may recommend you complete cardiac rehabilitation. Cardiac rehab can help speed your recovery while strengthening your heart. Our rehabilitation specialists provide gentle exercise, nutrition counseling and education in an outpatient setting.

Mitral Clip

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