Transcatheter Aortic Valve Replacement - TAVR
TAVR is an innovative valve replacement treatment for aortic stenosis. It delivers a new valve in a minimally invasive way, without removing the faulty valve.
The Porter Institute for Valvular Heart Disease is one of only a few centers in the Philadelphia area with the expertise to perform transcatheter aortic valve replacement.
Valve Repair without Open Chest Surgery
What is TAVR?
This procedure uses a catheter-based delivery system to place an expandable heart valve into the body. The process is similar to angioplasty.
During the TAVR procedure, a replacement heart valve is inserted either through a small cut in the leg and advanced to the heart, or through a small cut between the ribs and inserted through the apex, or tip, of the heart. It doesn’t require open-chest surgery and is done while the heart is still beating.
“TAVR enables us to replace a patient’s diseased valve without open-chest surgery and without stopping the patient’s heart. It’s a new option that could extend the lives of patients with aortic stenosis, and we are pleased to be able to offer it to our patients,” says Mauricio Garrido, M.D., cardiothoracic surgeon, Jefferson Abington Hospital.
The expandable valve being used in the TAVR procedure is the Edwards SAPIEN Transcatheter Heart Valve, which was first approved by the FDA in November 2011.
Edwards SAPIEN Transcatheter Heart Valve with the Retroflex 3 Transfemoral System
Edwards SAPIEN Transcatheter Heart Valve with the Ascendra Transapical System
Who is a Candidate for TAVR?
Standard valve replacement surgery is a good option for many patients. TAVR is most appropriate for those who cannot have valve surgery, including older patients, those at high risk for surgery, or those who were previously not eligible for surgery.TAVR recently won FDA approval.
“In general, candidates for TAVR are those patients who cannot safely undergo open heart surgery. Yet they must also be well enough to realize the expected benefit from fixing their aortic stenosis using the catheter-based approach,” says Bruce Klugherz, M.D., director, Catheterization Lab. “In other words, candidates must be considered high risk for open heart surgery, but stable enough to undergo TAVR. Once potential candidates for TAVR are identified, they undergo a series of tests to confirm that their anatomy is suitable, and they are evaluated by several members of the multi-disciplinary heart team.”
Our TAVR Team
A multi-disciplinary Heart Team has been established to offer TAVR procedures. The partnership between the cardiothoracic surgeon, the interventional cardiologist, the echo cardiographer and the anesthesiologist is critically important.
Pictured left to right: Vamshi K. Mallavarapu, MD,
Bruce D. Klugherz, MD, Peter B. Frechie, DO,
Philip S. Lim, MD, Emanuel J. Kostacos, MD,
Mauricio J. Garrido, MD, and Kelly A. Applebaum, CRNP
“Surgery, cardiology and anesthesia work closely together to manage each patient’s individual care,” says Garrido.
Benefits vs. Risks
No medical treatments prevent or delay the disease process of aortic valve stenosis and studies show that without treatment, 50 percent of patients with severe aortic stenosis will not survive more than two years after onset of symptoms.
TAVR provides an option for patients who are not likely to withstand an open-chest procedure. TAVR does involve general anesthesia and placement of the valve is associated with risks such as damage to the artery used for insertion of the valve, major bleeding and other life-threatening or serious events such as stroke or death. In addition, long term durability of the Edwards Sapien Transcatheter Heart Valve is still being investigated. “For some, TAVR is a viable choice – despite the risks – as it can relieve symptoms and extend life,” says Klugherz.
If you or a loved one suffers from aortic stenosis, ask your doctor about TAVR. For more information, please call 215-481-4200 or visit