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TAVR Turns 20, How This Procedure Has Evolved to Treat More Patients

Over the past two decades, TAVR has changed the way we treat aortic valve stenosis.

This year, we’re celebrating the progress that’s been made in treating patients with aortic valve stenosis—the narrowing of the aortic valve. Just over 20 years ago, patients would need to undergo open heart surgery to replace a dysfunctional valve.  But transcatheter aortic valve replacement (TAVR) allows patients to reap the benefits of a minimally invasive procedure which involves placing a replacement valve into the aortic valve’s location through a catheter.

“TAVR really revolutionized the way we treat aortic valve stenosis,” says Dr. Nicholas Ruggiero, director of Jefferson’s Cardiac Catheterization Laboratory and the Structural Heart Disease program. “With TAVR, patients can benefit from similar outcomes to surgical valve replacement, but with fewer complications and a faster recovery time.”

20 Years of Progress

In the 20 years since the first TAVR procedure, the patient profile and the procedure itself have evolved. When it was first performed, TAVR was only used with older, high-risk or inoperable patients with multiple conditions or severe symptoms. Now, the procedure is performed on patients as young as 65 years old who are experiencing symptoms of progressive aortic stenosis.

In addition, technology has rapidly progressed to make the procedure much safer and more effective. “Even just 10 years ago, the catheters we used were larger and came with a higher risk of complications like artery perforation and stroke,” says Rebecca Marcantuono, nurse practitioner and structural heart valve coordinator. “Now, we have much smaller catheters with state-of-the-art valves, allowing for excellent rates of success, minimized risk and minimal valve leakage.”

The pandemic has also changed the way that cardiology care teams reach their patients—thanks to telemedicine. “It became evident that we could accomplish a lot of the same things at screening and follow-up appointments through virtual visits without asking patients to come into an office or hospital setting,” says Marcantuono.

Dr. Ruggiero reflects that TAVR has also brought together a team of heart care professionals who used to work separately. “Cardiac surgeons and interventional cardiologists used to suggest different treatment methods, but TAVR has brought both groups to the table,” he says. “Now we’re operating with a multidisciplinary team of healthcare professionals, from surgeons to interventionalists, echocardiographers, radiologists and supporting staff, all working together to determine the best approach for each  patient.”

Benefits of TAVR Today and Beyond

The biggest benefit of TAVR, Dr. Ruggiero and Marcantuono agree, is the shortened recovery time for patients. Those who undergo surgical valve replacement face four to six weeks of recovery, including rehabilitation and minimized movement. But with TAVR, patients leave the hospital within 24–48 hours, and are back to normal life within a week. “We’ve treated patients who go off and play in a golf tournament a week later. TAVR really allows you to get back to your activities of daily living as quickly as possible,” says Dr. Ruggiero.

Regarding the future of TAVR, Dr. Ruggiero predicts that over the next 20 years it will become a viable option for other patient populations who aren’t currently candidates for the procedure. “We don’t currently treat people with leaky aortic valves, but there is an active trial for a valve that will help those patients, so progress is being made,” he says.

Both Dr. Ruggiero and Marcantuono expect to see TAVR as a standard treatment option at many more hospitals in the coming years.

“We believe in personalized medicine and shared decision-making,” says Marcantuono. “Leading edge care with caring,” says Ruggiero. “Our main goal is to always choose the option that’s best for the patient.”

[Main photo credit: iStock.com/Pixelimage]

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