Common Questions

• How does it work?
  A metal stent is guided into the heart to replace the aortic valve. Our Heart Team performs the TAVR through an artery in the leg, called the transfemoral approach. This approach works for 95% of TAVR recipients.
• Am I a good fit for the transfemoral approach?
  Your Heart Team will determine if the transfemoral approach is the right approach for you based on several factors. A CT scan is a very effective and important test that can decide if you’re a candidate for TAVR and if the transfemoral approach is right for you.
• If I am not a candidate for the transfemoral approach, can I still undergo 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.
• How do I get a TAVR evaluation?
  Anyone can be evaluated by contacting the Center for Advanced Valvular and Structural Heart Disease. Your physician will often refer you for an evaluation, or you or your family can request an evaluation.

• Prior to Your Procedure

  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

   

   

   

• During Your TAVR Procedure
  • 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

   

   

   

• After Your TAVR Procedure
  • 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