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What Is the TAVR Heart Procedure?


WHEN THE ROLLING STONES announced the postponement of their 2019 tour because Mick Jagger was having health problems, fans were understandably disappointed and a little worried. Jagger is, after all, 75 years old, and when it became apparent that he was having heart surgery, the concern rose – but not for Dr. Joseph Cleveland. A heart surgeon and professor of surgery at the University of Colorado Anschutz Medical Campus, Cleveland knew that Jagger would be back prancing the stage sooner than anyone knew. “I told people, don’t sell your tickets. He will be back in the fall,” Cleveland says.



In fact, Jagger and his bandmates will be back even sooner than that. The Stones rescheduled their Denver concert for August 10 – just four months after Jagger had his aortic valve replaced through a procedure known as transcatheter aortic valve replacement, or TAVR, surgery. Heart surgeons like Cleveland aren’t surprised. The TAVR procedure has helped transform the treatment of a potentially fatal disease, aortic stenosis.


Symptoms of aortic stenosis include:


· Chest discomfort or pain that may get worse with activity and reach into the arm, neck or jaw


· Cough, possibly bloody


· Breathing problems when exercising


· Becoming easily tired


· Feeling the heart beat (palpitations)


· Fainting, weakness or dizziness with activity



Without treatment, aortic stenosis can lead to heart attack, stroke and death.


What Is the TAVR Procedure?


As recently as about a half-dozen years ago, the only way to repair a stenotic aortic artery was through open-heart surgery. This surgery is very successful for otherwise healthy individuals, but aortic stenosis is typically a disease that affects older patients in their 70s and 80s who have other health concerns. Open-heart surgery is a big and taxing operation, involving the cracking of the rib cage to expose the heart muscle and putting the patient on a heart-lung machine to keep him or her alive while the heart is stopped for repair. It’s more than many elderly patients can handle. For them, there was no treatment for the disease.


In 2012, however, the Food and Drug Administration approved TAVR for these high-risk patients. This minimally invasive procedure replaces open-heart surgery. TAVR surgery is similar to the way interventional cardiologists install a stent into a blocked artery. The surgeon threads a catheter through an artery in the groin, usually the femoral artery – or occasionally through an artery in the chest, if the leg arteries aren’t suitable – to the heart and aortic valve. Various surgical tools are then threaded through the catheter to the site of the damaged valve. But instead of surgically removing the old valve, which is the procedure in open-heart repair, TAVR squeezes a collapsed replacement valve into the damaged valve’s place. The new valve is then expanded to push the old valve to the sides and take over, better regulating blood flow.

然而,在2012年,美国食品和药物管理局(Food and Drug Administration)批准将TAVR用于这些高危患者。这种微创手术取代了开胸手术。TAVR手术类似于将支架植入被阻塞动脉的方法。外科医生将导管穿过腹股沟的动脉,通常是股动脉——如果腿部动脉不适合的话,偶尔也会穿过胸部的动脉——到达心脏和主动脉瓣。然后将各种手术工具通过导管穿入受损瓣膜的位置。但是,TAVR并没有像开胸修复那样通过外科手术移除旧瓣膜,而是将一个塌陷的替换瓣膜挤压到受损瓣膜的位置。然后,新的瓣膜被扩大,将旧的瓣膜推到两侧并接管,从而更好地调节血液流动。

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