Women & Transcatheter Aortic Valve Replacement (TAVR)

Happy New Year! This month, I invited my colleague, interventional cardiologist Zvonimir Krajcer, MD to join me in educating our community about transcatheter aortic valve replacement (TAVR) procedures, which are gaining quite a bit of attention from women, as well as men.

Dr. Krajcer is a professional staff member at Texas Heart Institute, a founding member of our Texas Heart Institute Cardiac Society, and President of the International Society for Endovascular Specialists.  Through his research at Texas Heart Institute, Dr. Krajcer has pioneered this minimally invasive valve repair technique, which does not require major open-heart surgery, large incisions, or general anesthesia. Although this groundbreaking catheter-based technique is still less than 20 years old, it is helping more and more heart patients.

During National Heart Month, we thought this would be a great time to share some of the most recent information about TAVR. See below for our Q&A session with Dr. Krajcer.

What is TAVR?

TAVR (transcatheter aortic valve replacement), also called TAVI (transcatheter aortic valve implantation), is a minimally invasive technique to replace a diseased aortic valve without the need to open the patient’s chest. In this procedure, a catheter—a long, thin tube about the size of a pen—is inserted into the body through a small incision. The replacement valve is pushed through the catheter and put in place while the heart is still beating.

The TAVR procedure lasts about 1 to 3 hours and is performed under local anesthesia. Patients stay in the hospital for about 1 to 5 days but are mobile within 24 to 48 hours after the procedure. There are 3 common approaches for performing a TAVR:

  • Transfemoral – An incision is made in the upper leg/groin area to access the femoral artery, through which the catheter is inserted. Some interventional cardiologists insert the catheter percutaneously (by puncturing the skin), using local anesthesia.
  • Transapical – A small incision is made in the chest between the ribs to access the large artery that enters the apex of the heart.
  • Transaortic – The incision is made in the upper chest (top of sternum) to access the opening of the aorta—the large artery through which blood flows after it is pumped out of the heart through the aortic valve.

What is the difference in TAVR outcomes for women vs men?

Results from a clinical trial suggest that TAVR may be a better option for women who are deemed high risk for having open-heart surgery. The studies also show that the risk of death associated with TAVR is lower in women than in men.

What is the replacement valve used in TAVR made of?

The TAVR valve is made of natural tissue from the heart of a pig or cow.

How does the TAVR valve work?

Because the TAVR valve is inserted through a catheter, the valve must be folded up like an umbrella beforehand. Once the TAVR valve is placed in the heart, it is expanded to its working size inside the old valve, thereby forcing the old valve out the way.

Why is TAVR done?

The aortic valve is a circular opening with a one-way valve that allows blood to be pumped from the heart to the rest of the body. If the aortic valve becomes narrowed (for example, by stiffening of the aortic valve leaflets), the heart muscle is forced to work harder to get blood through the valve, which can cause discomfort and chest pain. TAVR widens the aortic valve opening by replacing the narrowed aortic valve.

How is TAVR different from the standard valve replacement?

TAVR is a transcatheter, interventional procedure that replaces the aortic valve instead of removing it. Also, the procedure is less invasive than the standard valve replacement operation because patients do not need to be supported by a heart-lung machine and do not need their chest cavity opened.

Evidence suggests that TAVR is more beneficial—in both the short and the long term—for patients who are considered intermediate or high risk for open-heart surgery.

What makes a patient a good candidate for the TAVR procedure?

  • Severe aortic stenosis and symptoms like chest pain, fatigue, heart failure, lightheadedness/fainting, shortness of breath, difficulty when exercising, and irregular heartbeats
  • Symptoms that have not improved with medication
  • Being diagnosed with symptomatic aortic stenosis and having other conditions that make an open-heart operation risky. Most people who have the TAVR procedure are in their 70s and 80s

What makes a patient not a good candidate for the TAVR procedure?

  • Having only mild to moderate aortic stenosis
  • Blood vessels and valves that are too small for TAVR
  • Other untreated heart problems
  • Having had a heart attack within the last 30 days
  • Having another severe, untreated medical illness or infection
  • Being only at low risk from an open-heart operation (the reason for this is explained below)

Your doctor is the best person to help you decide which procedure (TAVR or the conventional open-heart operation) is best for you.

Do women and men benefit equally?

We still don’t have enough information about the direct relationship between men and women and the benefits of TAVR. Women have a higher risk of death than men following any surgical valve replacement due to women’s smaller size.

In contradiction, new clinical trials of the TAVR procedure showed that women benefited more than the men. In a recent clinical trial, women had better outcomes than men 1 year after having a TAVR procedure. In another recent clinical trial, Female TAVR patients were about 40% less likely to die within 2 years than male TAVR patients.

Conducting outcomes research to gain knowledge about the direct benefits of TAVR in men and women is a major research focus for our team in 2018.

Do more men or women have TAVR?

More men than women have TAVR procedures. The reasons for this discrepancy are not clear.
How long will the replacement valve from the TAVR procedure last?

Current studies indicate that TAVR valves last about 5 years without any signs of wear and tear; however, this depends on the patient’s age and other medical conditions. Because the valves cannot be counted on to last more than 5 years, younger and lower-risk patients are not considered the best candidates for the TAVR procedure.

What are the risks of TAVR for men and women?

Some risks for all patients to be aware of before undergoing the TAVR procedure include the following:

  • Death (1%)
  • Stroke (1.5%)
  • Valve leak (3%)
  • Need for pacemaker (7%)
  • Kidney failure (0.5%)
  • Vessel damage (3%)

Want to meet Dr. Krajcer and learn more?

Dr. Krajcer will be the special guest speaker at the WomenHeart Houston support group meeting on Wednesday, March 14, 2018 at 11:30 AM. For more information and to contact the support group to RSVP, visit our events web pages online.

Happy Heart Month!

Stephanie Coulter, MD

Thank you to Jackie Ferrufino, Dr. Karla Campos and Keri Sprung for their assistance in this issue of Straight Talk.

We have many events scheduled during Heart Month. Visit our News/Events section for events around Houston.  Join us at the 3rd Annual Pilates Has Heart in Honor of our dear friend Terri Dome

Are you a woman living with or at risk for heart and vascular disease and needing support? 

Join us at an upcoming WomenHeart Houston support group meeting on Valentine’s Day, February 14th. Dr. Mehdi Razavi will be there to answer questions about arrhythmias, including the most common heart rhythm condition: atrial fibrillation. Be sure to check the website for the latest information!

How can you help others?

  • Spread the word: Amazing infographics about women’s heart health, heart anatomy, heart-healthy recipes, fitness, and more are posted on the Texas Heart Institute Pinterest page
  • Share your story: Send pictures to womenheart@texasheart.org and share your activities with us during National Heart Month. We want to hear from you!
  • Read and share our Straight Talk newsletter articles