Transcatheter aortic valve replacement

Recently I had the experience of caring for patients on a hospital’s telemetry floor. One of my patients had just received a transcatheter aortic valve replacement (TAVR), sometimes referred to as transcatheter aortic valve implantation (TAVI). The TAVR procedure is a new cardiac procedure being performed at the hospital. TAVR procedures have been performed in Europe since 2007, but were only approved by the FDA in the United States in 2011 (Buntz, 2012). A transcatheter aortic valve replacement is used as an alternative to traditional aortic valve surgery in patients with aortic stenosis who, either because of age or comorbidities, are not candidates for traditional cardiac surgery (Khatri et al., 2013). The TAVR procedure does not require a sternotomy, but instead threads a balloon catheter with the replacement valve through the femoral artery (transfemoral approach) and into position (American Heart Association, 2015).

The research efforts of Khatri et al. (2013) investigate the adverse effects associated with transcather aortic valve replacement and attempt to identify if certain approaches (transarterial or transsapical) or types of valves (CoreValve or Sapien valve) have different adverse effects. From their research Khatri et al. (2013) concluded that heart block, vascular complications, and acute renal failure were the most common side effects of the TAVR procedure. The CoreValve was more often associated with heart block but less likely to cause vascular complications (Khatri et al., 2013). In addition, the transapical approach has lower thirty day survival rates than the transfemoral approach (Khatri et al., 2013). The study highlights the fact that most patients receiving the TAVR transapically had significant peripheral vascular disease and therefore greater comorbidities than those who’s vasculature was adequate for the transfemoral approach (Khatri et al., 2013). Further research is needed to assist physicians in making decisions about the best valve types and approach to use when preforming the TAVR procedure.

References

American Heart Association. (2015). What is TAVR? In Heart valve problems and disease. Retrieved from http://www.heart.org

Buntz, B. (2012). TAVR: Still the next big thing in cardiology? Medical Device and Diagnostic Industry. Retrieved from http://mddionline.com/article/tavr-still-next-big-thing-cardiology

Khatri, P., Webb, J., Rodes-Cabau, J., Fremes, S., Ruel, M., Lau, K., … Ko, D. (2013). Adverse effects associated with transcatheter aortic valve implantation: A meta-analysis of contemporary studies. American College of Physicians, 158, 35-46.