If you’ve had open-heart aortic valve replacement and need further repair, your options just got better.
Valve-in-valve transcatheter aortic valve replacement (TAVR) is a minimally invasive and effective alternative to a high risk open-heart procedure. TAVR repairs the valve without removing the old, damaged valve. Instead, it wedges a replacement valve into the aortic valve’s place. A new artificial valve attached to a thin catheter is compressed and fed through an artery until it reaches the aortic valve where it is nestled inside the old valve. Once in place, a balloon expands the artificial valve and the catheter is removed.
The University of Miami Health System is one of the sites in the U.S. pioneering this procedure and has been doing it longer than any hospital in Florida. Specialists are involved in clinical trials for new transcatheter valves and new applications for them.
An alternative to open-heart surgery
Usually valve replacement requires an open-heart procedure with a sternotomy, in which the patient’s chest is surgically opened to allow surgeons access to the heart. The existing aortic valve is replaced with a new one. If that valve fails, historically, a second open procedure could place you at a much higher risk, especially if you have other medical conditions, such as lung or kidney problems.
Now, the TAVR procedure is performed using one of two different approaches, allowing the cardiologist or surgeon to choose which one provides the best and safest way to reach the valve:
- Entering through the femoral artery (large artery in the groin), which does not require a surgical incision in the chest, or:
- Using a minimally invasive surgical approach with a small incision in the chest and entering through a large artery in the chest or through the tip of the left ventricle.
Dr. Amit Patel, chief of cardiothoracic surgery at University of Miami Miller School of Medicine is excited about the effectiveness of this technique. “Our heart team matches the approach to our patients’ individual medical status and preferences, providing a drastically reduced risk and greatly increased benefit for solving their heart valve problems,” he explains.
What to expect
Your experience with a TAVR procedure may be comparable to a balloon treatment for a clogged artery or even an angiogram in terms of down time and recovery, and will likely require a shorter hospital stay (average two days). You could go home the next morning. The valve-in-valve procedure drastically reduces your risk and is FDA-approved for all moderate to high risk patients. You may also have the procedure as a low-risk patient, but currently only as part of a clinical trial.
If your concern is with general anesthesia, Dr. Patel explains, many of the TAVR valve-in-valve procedures are done with only I.V. sedation, allowing a next morning discharge. Your doctor will go through your history to help determine if this procedure is the correct choice for you.
The University of Miami Health System is home to the Elaine and Sydney Sussman Cardiac Catheterization Lab, which provides advanced imaging capabilities and pinpoint accuracy for new and complex procedures such as TAVR, mitral valve repair and other minimally invasive procedures, such as valvuloplasty, and other coronary and peripheral vascular interventions.