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Aortic valve replacement (AVR) is one of the most effective and rewarding procedure in the history of medicine. It can restore normal function in patients facing a sure death without intervention. It is remarkably safe and effective. It does however have its limitation and some patients are too frail to be even considered.

Transcatheter aortic valve replacement (TAVR) has been shown to be a good alternative option for patients who cannot undergo a standard AVR. The indications for performing TAVR have been expanded to not just individuals thought to be inoperable but also for those deemed high risk for standard surgery.

The standard approach is through the femoral artery in the groin. The catheters are advanced across the aortic arch to reach the aortic valve at the root of the aorta. A balloon valvuloplasty of the stenotic aortic valve is performed first to enlarge the opening and the stented bovine pericardial valve is then deployed in place. General anesthesia is used however cardiopulmonary bypass and arresting the heart are usually not needed. Recovery is typically much faster and easier than after AVR. Alternatively it can be performed through a small incision in the chest.

TAVR is a procedure that is developing and improving quickly. The rate of complications (such as stroke and leaking around the valve) continues to fall due to improvements in the technology. Long term data is still not available and some questions are yet to be answered. Currently, it is not considered as an equivalent alternative to standard aortic valve replacement for otherwise healthy individuals but one day, it may become one.

If you or your loved one is in need of a new aortic valve you should consider the standard open surgery as well as TAVR. When performed by reputable surgeons, traditional AVR is done with very little complications, manageable postoperative pain and predictable longterm durability. Over the last 18 years we have performed this procedure at Clear Lake Regional Medical Center on hundreds of patients (some of them in their 90’s) with outstanding results. Our outcomes have been consistently better than the national average.

Texas Surgical Associates