What Is the TAVR Heart Procedure?

Health Problems

When the Rolling Stones announced the postponement of their 2019 tour because Mick Jagger was having health problems, fans were understandably disappointed and a little worried. Jagger is, after all, 75 years old, and when it became apparent that he was having heart surgery, the concern rose – but not for Dr. Joseph Cleveland. A heart surgeon and professor of surgery at the University of Colorado Anschutz Medical Campus, Cleveland knew that Jagger would be back prancing the stage sooner than anyone knew. “I told people, don’t sell your tickets. He will be back in the fall,” Cleveland says.

(Getty Images)

In fact, Jagger and his bandmates will be back even sooner than that. The Stones rescheduled their Denver concert for August 10 – just four months after Jagger had his aortic valve replaced through a procedure known as transcatheter aortic valve replacement, or TAVR, surgery. Heart surgeons like Cleveland aren’t surprised. The TAVR procedure has helped transform the treatment of a potentially fatal disease, aortic stenosis.


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To deliver blood to the rest of your body, the heart pumps it into the aorta, the main artery, through a valve that opens and closes to keep blood flowing in the right direction. As we age, however, calcium deposits may collect on the valve, causing it to become stiff and inflexible. It may eventually reach the point where it doesn’t open fully. This is called aortic stenosis, and it impedes blood flow from the heart.

Symptoms of aortic stenosis include:

  • Chest discomfort or pain that may get worse with activity and reach into the arm, neck or jaw.
  • Cough, possibly bloody.
  • Breathing problems when exercising.
  • Becoming easily tired.
  • Feeling the heart beat (palpitations).
  • Fainting, weakness or dizziness with activity.

Without treatment, aortic stenosis can lead to heart attack, stroke and death.

What Is the TAVR Procedure?

As recently as about a half-dozen years ago, the only way to repair a stenotic aortic artery was through open-heart surgery. This surgery is very successful for otherwise healthy individuals, but aortic stenosis is typically a disease that affects older patients in their 70s and 80s who have other health concerns. Open-heart surgery is a big and taxing operation, involving the cracking of the rib cage to expose the heart muscle and putting the patient on a heart-lung machine to keep him or her alive while the heart is stopped for repair. It’s more than many elderly patients can handle. For them, there was no treatment for the disease.










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In 2012, however, the Food and Drug Administration approved TAVR for these high-risk patients. This minimally invasive procedure replaces open-heart surgery. TAVR surgery is similar to the way interventional cardiologists install a stent into a blocked artery. The surgeon threads a catheter through an artery in the groin, usually the femoral artery – or occasionally through an artery in the chest, if the leg arteries aren’t suitable – to the heart and aortic valve. Various surgical tools are then threaded through the catheter to the site of the damaged valve. But instead of surgically removing the old valve, which is the procedure in open-heart repair, TAVR squeezes a collapsed replacement valve into the damaged valve’s place. The new valve is then expanded to push the old valve to the sides and take over, better regulating blood flow.

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Whereas open-heart valve repair can take five to seven hours, requires up to a week in the hospital and several months of post-surgery recovery, TAVR takes about one to two hours and the patient often goes home the next day. TAVR recovery is much less arduous as well. “We want them to take it easy – no high exertion, no strenuous activities –for one week, to allow the femoral artery to heal,” says Dr. Vinod H. Thourani, chair of the department of Cardiac Surgery at MedStar Heart & Vascular Institute in Washington, D.C., and a member of the American College of Cardiology Surgeons’ Council. “They go home on low-dose aspirin,” he says, to help prevent blood clotting, and some get a second blood thinner, like Plavix. After that, they are free to do as much as they can –which is usually more than they have done in years.










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Who Qualifies for the TAVR Procedure?

The surgery has been so successful for high-risk patients that it was approved for those at medium risk a few years ago. (Risk is determined by many factors, including age, overall health and other diseases.) And heart surgeons expect the FDA will soon approve the procedure for low-risk patients, meaning that just about anyone with a stenotic aortic artery will qualify for the procedure.

This is based in part on a landmark study published in March 2019 in the New England Journal of Medicine. The study followed 1,000 low-risk patients who had either TAVR or open-heart surgery and concluded that the chance of death, stroke or rehospitalization at one year after the procedure “was significantly lower with TAVR than with surgery.”

“The study shows that TAVR is superior (to surgery) in low-risk patients,” says Thourani, a co-author of the study, supporting other studies that show it to be at least as good as open-heart surgery. But TAVR is not a panacea, he adds. Even if and when it is approved for low-risk patients, there are still some who do not qualify for the TAVR procedure. Those with a congenital heart defect called bicuspid aortic valve, patients who also have an aortic aneurysm or those whose blood vessels are not big enough to support catheterization are among the patients who don’t qualify for TAVR.



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