Kootenai Health

Coeur d`Alene, North Idaho, Washington, Montana, Spokane

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TAVR

As our bodies age, our muscles, organs and other systems become more prone to disease or failure. Aortic stenosis, the narrowing and hardening of the aortic valve, is one of the more common and serious heart problems many people experience as they age. Although surgical replacement of the valve can treat the problem, it can also be strenuous on those who are at a higher risk of complications or
who may have other severe health problems.

TAVR (transcatheter aortic valve replacement) allows a new valve to be inserted through a catheter rather than via open-heart surgery. The new valve is inserted within the diseased valve, allowing it to function properly. The catheter is typically inserted through the leg,
but it can also be inserted through the arm or chest. The total procedure typically lasts about an hour.

The recovery process is easier than open heart surgery, and most patients are able to go home and resume their normal daily activities just two or three days after the procedure.

The extensive preoperative screening and evaluation process involves a number of different tests and physician evaluations. Prior to surgery all stakeholders (including physicians, coordinators and others) work together to determine the best course of action and how to perform the surgery for the best possible outcome.

The preoperative screening, testing and follow-up visits are available in both Spokane and Coeur d’Alene.

To view an animation of the procedure, click here.

Do you think you are a good candidate for the TAVR procedure? Contact Kootenai Heart Clinics Northwest to make an appointment with a cardiologist.

TAVR Patient Testimonial

John Schuessler of Sandpoint, Idaho, had the TAVR procedure completed in November 15, 2015.

What happened?

“I had a heart murmur since I was born, but around my 81st birthday my primary care doctor detected a faulty valve and mentioned it to the doctors at Kootenai Heart Clinics Northwest. I went to the heart doctor and it was a good thing. I was feeling it [unwell]. They examined me and told me I was going down fast. I was told me that if I pass this test there is a new procedure, [the TAVR], that allows them to insert a new valve [through a catheter rather than open heart surgery].”

What was your experience in completing the TAVR procedure?

“I haven’t been in the hospital in a long time. It was very good. Informative. The staff were great. I enjoyed them all. It was very easy. I recommend it.”

How do you feel now?

“Before I was out of breath all the time, especially when doing something active. I’m glad they caught it in time. Now I feel better. I’ve got stamina now. I have a wood stove and I cut wood, saw wood, stack wood and chop wood. It keeps me busy in the summer and spring. I’ve rehabilitated myself and got stronger.  It’s a good change.”

TAVR Procedure Frequently Asked Questions

After the surgery date is decided, what happens next?

You will receive instructions before your surgery about how to prepare, which medications to stop and directions about where to go and park the morning of the procedure. You will likely need to complete 1 or 2 additional appointments before surgery:

  • If you have not seen a second Cardiac Surgeon, we will schedule you for that appointment. Medicare requires that patients are evaluated by two surgeons, to determine you risk for surgery.
  • You will also be scheduled for a Pre-Surgical Screening appointment; this will take 1-2 hours and is the final check of blood work, chest x-ray and urine sample. To make sure you are stable prior to TAVR. A cardiac nurse from the hospital will meet with you to review your medications (please bring a list), any allergies, what to expect the morning of, and instructions for care at home after discharge.

What will happen the day of the procedure?

You will check in to the “Surgery/Procedure Check in Area” Located on the Heart Center by entering the South Entrance and using the elevator to the second floor. You will need to arrive several hours before scheduled surgery, so the nurses have time to start IV lines, prepare you for the procedure. You will meet with the anesthesiologist. Once you are in the Operating Room and the procedure begins, it usually lasts about an hour. There will be a period of bedrest required after the surgery (usually 6 hours), during which time we will need you to keep your legs straight. This will make sure your incision site starts to heal. If you have any concerns with lying flat, become uncomfortable or experience pain during this time, please communicate this to the nurse caring for you.

How long do I stay in the hospital?

Most patients spend 1-2 nights in the hospital. Your stay may be longer if we need to continue to monitor you.

Will I need help at home after discharge?

You may need to make arrangements for someone to stay with you the first week after returning home, to help with daily activities, such as cooking, and grocery shopping. Every patient recovers differently, and having help at home for support is important. If you feel more help is needed, such as visiting nurses or physical therapy please let us know.

Once I go home, what are the restrictions?

You may gradually return to your normal activities after returning home, with the following exception.

  • For one week (7 days) after the TAVR, do not lift, push, or pull anything heavier than 10 pounds.
  • Daily exercise is important for your healing. Regular exercise helps strengthen the heart muscle. A walking program is encouraged after your return home, along with continued use of your incentive spirometer.
  • Before you leave the hospital, one of the nurses will also refer you to the nearest Cardiac Rehab program. This is an optional outpatient Cardiac exercise program to help increase activity, rebuild strength, stamina and balance.

What about showering and bathing?

You may shower when you get home. Gently wash the incisions with mild, unscented soap and water.

Pat incisions dry, do not rub them.

Do not soak in a bath tub, hot tub, pool etc. until the incision(s) has fully healed, without scabs.

What things should I watch for with my incision?

Please call your Cardiology team right away if you have any of the following:

  • Redness around the incision
  • New drainage
  • Warmth or heat at the incision
  • Fever of 101 degrees or greater
  • Worsening bruising, pain, or swelling at the incision site

What about shortness of breath or swelling in the legs or ankles after the procedure?

Aortic stenosis often causes congestive heart failure because the heart muscle has to work hard to pump blood through a very narrow aortic valve opening. This makes the heart muscle thick and stiff.

After TAVR, these changes in the heart muscle take time to improve. Some symptoms associated with heart failure are:

  • Shortness of breath
  • Ankle and leg swelling
  • Fatigue

Congestive heart failure may cause you to have too much fluid in your body after TAVR. We can help manage this with medications called diuretics (water pills).

Weight gain is one of the signs that you may have too much fluid buildup.

  • Weigh yourself every day, first thing in the morning after you have emptied your bladder.
  • Record this weight
  • If you notice a gain of 3lbs overnight or 5lbs in a week, or you have symptoms of congestive heart failure call your cardiology team.

When can I expect to begin feeling better after the procedure?

Each patient is different – some immediately notice that symptoms are better. Others experience a gradual improvement and can take up to 3 months to notice the full benefits and for some it can be even longer.


What kind of follow up appointments should I expect after the procedure?

You should see your Primary Care Provider one week after discharge.

You will also be scheduled to see your TAVR Cardiologist with an echocardiogram in one month and again at 1 year after TAVR.


What about long-distance traveling or flying? How long after the procedure do I need to wait?

Once you have completed your 1 month follow up appointment, you will be cleared for long distance travel and flying. Metal detectors at the airport: The amount of metal used in the TAVR valve is very small and dos not usually set off a metal detector. If for some reason the metal detector is activated, show the security staff your patient device ID card. The metal

detector will not harm your heart valve.


Are there special requirements for future dental work or medical procedures?

Please delay any elective dental work for six months after your TAVR procedure.

In order to prevent bacteria from entering the bloodstream (and potentially affecting the heart valve) antibiotics will need to be taken 1 hour before certain medical procedures (for example, dental cleanings and dental work, as well as some surgeries). This will be a requirement for the remainder of your life. Please call your Cardiology team if you need any procedures or dental work completed. We will advise you on the antibiotics you will need to take beforehand.

 

What about imaging, such as CT or MRI scans?

We recommend you wait at least 30 days after your TAVR valve to have a CT or MRI scan completed. Please be sure to inform your doctor that you have an artificial heart valve, and show the personnel your patient device ID card.

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