TAVR

Yes! There are alternative ways to deliver the TAVR valve to the heart, including:

• Transcaval: Rochester Regional Health is one of the few centers in the United States routinely offering transcaval procedures. Your Heart Team doctors will create a temporary connection between a vein in your leg and an artery in your abdomen to perform TAVR, and your recovery will be the same as a transfemoral approach.

• Transaxillary or Transcarotid: Both require general anesthesia and a breathing tube, which is usually removed after surgery. Your surgeon will make an incision in your arm or neck to insert a catheter and deliver the TAVR valve. Recovery is longer than a transfemoral or transcaval approach.

• Transaortic or Transapical: Both approaches require general anesthesia and a breathing tube, which is usually removed after the procedure. Your surgeon will make an incision between your ribs or through your sternum (breastbone) to insert a catheter and deliver the TAVR valve. Recover is longer than a transfemoral or transcaval approach.

Our team will provide you with specific instructions on preparing for your TAVR procedure

• This will include any medications that we would like you to hold prior to the procedure
• In general, you should take all other medications as prescribed

• Activity
  • It is OK to maintain your current level of activity including exercise
  • If you develop symptoms, then STOP and rest
  • If you develop any new symptoms, then please inform your physician
• Diet
  • Continue to eat a healthy, low salt diet
• Make a Recovery Plan
  • It is very important to plan for the following:
    • Who will take me home?
    • Who will stay with me the day I am discharged?
      • Generally, we recommend that someone stay with you for the first few days following the procedure
    • Do I have help for preparing meals, driving, or other household chores during the first few days following the procedure?
  • The day before the procedure
    • You likely will be asked to have your blood drawn to have updated labs and preparation of blood products
      • We prepare blood products for each patient that is matched to your blood type in the unlikely event of a bleeding complication
      • This requires wearing a special wrist band that is placed by the lab to your procedure
    • Do not eat anything after midnight or the morning of your procedure
      • It is ok to have small sips of water to take your morning medications

• The procedure is performed at Rochester General Hospital
• You will be given specific instructions on where to go on the day of the procedure
• You will meet the anesthesiologist prior to the procedure
  • TAVR does not require general anesthesia with a breathing tube
    • Unless you undergoing an alternative access approach for the procedure (i.e., not transfemoral)
  • For the transfemoral approach, we routinely use conscious sedation for relaxation and to eliminate any pain
• The procedure takes about 45 minutes to an hour to perform
• As with any medical procedure, there are risks and anything can happen.
  • The most serious risks of TAVR include: death, stroke, vascular complications, and bleeding events requiring transfusion and/or immediate surgery
  • Pacemaker implantation is one of the most common risks (5-10% of patients)
• During the transfemoral procedure, we will typically:
  • Access a leg artery in both groins (one larger tube for the valve and a smaller tube to take pictures with X-ray dye to position the valve)
  • Place a temporary pacemaker through a vein in the leg or neck to rapidly pace the heart while placing your new heart valve
    • The temporary pacemaker is removed at the end of the procedure unless there is a concern that you may need a permanent pacemaker

• The recovery time for a transfemoral procedure is fast!
  • Recovery is different for alternative access TAVR and your physician will discuss these differences with you
• Your symptoms may be better shortly after the procedure
• Recovery occurs in our post-procedural recovery area
• You will ambulate within 2-4 hours of the procedure
• Most patients are discharged the morning after the procedure but about 10% of patients may leave on the same day as their procedure     
  • If you stay overnight, then you will be assigned a bed on one of our cardiac hospital floors
• Our criteria for discharge is:
  • You do not have any bleeding issues at the sites used for vascular access
  • You can ambulate without any major limitations
  • You do not need a pacemaker
    • We may have you wear a home monitor to follow your heart rhythm after the procedure
  • You feel well and have a recovery plan!
• We will give you detailed instructions about any restrictions and new medications following the procedure
  • You will be on certain medications to prevent clot from forming on the valve or stroke but this will be individualized for each patient
    • You will also need to take an antibiotic prior to any procedure (including dental work) to reduce the risk of infection
  • Most patients can resume full activity including driving 5 days after the procedure
• Follow-up
  • You will see your primary cardiologist or a provider in the Center for Advanced Valvular and Structural Heart Disease within 1-2 weeks of the procedure
  • You will undergo an echocardiogram at 30 days and 12 months and either be seen in our valve clinic or contacted for a telephone follow-up visit