TAVR: Transcatheter Aortic Valve Replacement

Transcatheter Aortic Valve Replacement, or TAVR, is a minimally invasive procedure to repair a damaged valve by inserting a replacement without removing the old, damaged one.

TAVR is performed on patients with aortic stenosis, initially only those classified as high risk or inoperable. All patients are carefully evaluated by a Heart Team comprised of interventional cardiologists, cardiothoracic surgeons, imaging specialists, advanced practitioners, and nurses to see if they are candidates for traditional surgical aortic valve replacement or if TAVR would be the best treatment option.

The procedure, is an alternative to open-heart surgery. And, because it’s less invasive than traditional surgery, patients recover more quickly (and, on average, they go home after one to two days in the hospital).

How To Replace A Heart Valve Without Open Heart Surgery
 

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After the Food and Drug Administration approved the artificial valve used in TAVR in 2011, doctors at the Heart & Vascular Institute at Hartford Hospital were the first in the state to perform the procedure. Since then, they have performed more than 1,000 TAVR procedures, making the Heart & Vascular Institute the largest program in the state and one of the largest in New England.

TAVR is a collaboration between interventional cardiologists and cardiothoracic surgeons. Our physicians have performed TAVR procedures using a range of approaches -- transfemoral, subclavian, transapical, direct aortic and transcarotid -- selecting the best design for each patient’s needs.

The hospital’s clinical work has been complemented by research. Hartford HealthCare physicians have served as the principal investigators in multiple multicenter national trials documenting the safety and efficacy of TAVR and leading to FDA approval for TAVR use in extreme-, high-, intermediate- and low-risk patients.

Conventional open-heart surgery to replace the aortic valve usually requires an incision across the sternum (breast bone), a heart lung machine that takes over for the patient's heart during the procedure and the removal of the diseased aortic valve. In a TAVR procedure, an interventional cardiologist works with a cardiothoracic surgeon, guiding a new valve through an incision in the leg as the patient's heart beats. The new valve is placed within the diseased aortic valve.

How long does a TAVR procedure take?
The time required will depend on your health and the approach used by your doctors: transfemoral, subclavian or transcarotid. The procedure usually lasts 1.5 hours. The average open heart surgery lasts about four hours.

How long is recovery from TAVR?
TAVR patients spend about one to two days in the hospital. Recovery from a TAVR procedure is typically about a week, compared with three months for a surgical-valve replacement.

How long will the new heart valve last?
Because of the many variables in assessing a valve’s lifespan, your Heart Team will usually instruct you to follow up with your clinical cardiologist regularly to assure the valve is functioning properly. We use echocardiograms to monitor the valve.

Dr. Robert Hagberg, chief of cardiac surgery at Hartford Hospital, said the popularity of TAVR is growing because patients often tolerate it better than open-heart surgery and face a faster recovery. “It’s actually competing with standard surgical aortic valve replacement now because TAVR is becoming mainstream,” Hagberg said.


What is aortic stenosis?

Aortic stenosis, often related to age, can be caused by mineral deposits (calcium) on the aortic valve's leaflets. Eventually, the leaflets stiffen and lose their capacity to open completely, making it more difficult for the heart to pump blood through the aortic valve to feed the rest of the body. Because blood now has less oxygen, it can cause symptoms like shortness of breath, lightheadedness, fatigue and chest pain.

An estimated 2.5 million people over age 75, or more than 12 percent of that demographic in the United States, have aortic stenosis. And 80 percent of adults with the disease are male. An estimated 50 percent of people with severe aortic stenosis will die, on average, within two years if they do not have their aortic valve replaced.

How is aortic stenosis diagnosed?
Your doctor can use several tests, starting with an evaluation of your heart through a stethoscope. An echocardiogram, which uses ultrasound waves to produce video images, provides more definitive evidence. Only a hospital with a TAVR program, such as Hartford Hospital, can evaluate you for both TAVR and open heart surgery. Before a TAVR procedure, your doctor also might use cardiac catheterization to check your heart arteries (coronary, abdominal and pelvic) for blockages. A CT scan also can determine if your arteries can accommodate a new valve delivered via a catheter. We also evaluate your lung function and assess narrowing or plaque buildup in your carotid arteries.


A TAVR Innovation

Dr. Mohiuddin Cheema and Dr. David Underhill of the Heart & Vascular Institute are pioneers.

In September 2016, Dr. Cheema performed the first TAVR procedure in New England that implanted a new cardiac valve through the carotid artery in a patient’s neck.

In the most common TAVR technique at the Heart & Vascular Institute at Hartford Hospital, a new cardiac valve is implanted in a patient’s heart through an artery in the groin. Unfortunately, this approach cannot be used in all TAVR patients if their groin arteries are diseased or are simply too small. In the past, the only option involved implanting the TAVR valve using alternative techniques that required surgically entering the patient’s chest.

HVICheemaUnderhill.jpg

Following the first successful transcarotid procedure, a similar approach has been used by both Dr. Cheema (at left in photo) and Dr. Underhill (at right in photo) in treating an additional 21 TAVR patients. (TAVR surgery is performed on a beating heart and does not require cardiopulmonary bypass.)

Transcarotid TAVR can only be performed by doctors who have been trained in both cardiac and vascular surgery.

“Our successes with TAVR and carotid vascular surgery afford us the ability to draw on both experiences to offer patients a less invasive solution,” says Dr. Underhill, the first cardiothoracic surgeon, in early 2012, to perform a conventional TAVR procedure at Hartford Hospital.

“The success of the carotid artery technique,” says Dr. Cheema, “has allowed our team to stop performing the TAVR procedure through alternative surgical techniques that have higher rates of patient discomfort and complications.”  

“It pushes the envelope," says Dr. Robert Hagberg, Chief of Cardiothoracic Surgery, who assisted in the Heart & Vascular Institute’s first transcarotid TAVR with Drs. Cheema and Underhill. "It pushes us to explore things we might not have thought about before. It's medicine that takes care of patients in a better way."

The carotid approach has been so successful that Dr. Cheema, who has dual board certifications in cardiac and vascular surgery, has begun a training program to begin teaching physicians, and TAVR programs, across the country how to perform the transcarotid TAVR procedure.


TAVR Nurse Navigator

A friendly face … a skilled helping hand. With Hartford HealthCare’s nurse navigators, TAVR patients and their families are never alone.

Starting with the first meeting between doctor and patient, nurse navigators serve as advocate, educator and source of encouragement. They help develop an individualized care plan for each patient, explaining it in easy-to-understand terms. They coordinate appointments and tests, and follow up on treatment decisions. They’ll even arrange translation services, if needed.

A nurse navigator helps coordinate the work of doctors, nurses, advanced practitioners and staff members who work with TAVR patients. Our nurse navigator, Courtney Hurlbert, works with the Structural Heart Advanced Practitioners -- nurse practitioners Lauren Curtis, Susan Erwin and Agnes Piechota, and physician’s assistant Nicole Hoover – to help educate and care for every patient. At the Hartford HealthCare’s Heart & Vascular Institute, we put the patient (and family) first.

Courtney has an extensive background in patient education and cardiology.  She takes what seems overwhelming and makes it manageable for you.

Meet Courtney Hurlbert, Nurse Navigator

HVICourtneyHurlbertNavigator.jpgI am a master’s prepared nurse with experience in cardiology and certified as a Clinical Nurse Leader (CNL). I will be there every step of the way as your educator, source of encouragement, resource and advocate from pre-procedure to inpatient and even after discharge from the hospital. I’m here to help you and your family across each transition.

After your first meeting with one of our program coordinators and your physician, I will work closely with them on your behalf to make sure you have the best understanding of your individualized care plan. Together, we’ll make sure our plan addresses your goals for recovery.

Nurse practitioners Lauren CurtisSusan Erwin and Agnes Piechota, physician’s assistant Nicole Hoover and I will become your go-to communicators by coordinating appointments and tests and following up on treatment decisions. I look forward to meeting you with the rest of our TAVR team members.


Meet our TAVR Specialists:

Name Specialties Location
Azemi, Talhat, MD, FACC Azemi, Talhat, MD, FACC
4.9 /5
59 surveys
860.972.5083
  • Interventional Cardiology
  • Cardiovascular Medicine
  • Echocardiography
  • Endovascular Medicine
  • Internal Medicine
  • Nuclear Cardiology
  • Vascular Medicine
Show Less
  • Hartford
  • Norwich
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Carreras, Edward Thomas, MD, FACC, FSCAI Carreras, Edward Thomas, MD, FACC, FSCAI 203.380.3910
  • Cardiovascular Medicine
  • Echocardiography
  • Internal Medicine
  • Interventional Cardiology
Show Less
  • Stratford
  • Bridgeport
  • Milford
Show Less
Cheema, Mohiuddin, MD Cheema, Mohiuddin, MD
4.9 /5
174 surveys
860.696.5520
  • Cardiac Surgery
  • Endovascular Surgery
  • Vascular Surgery
Show Less
  • Hartford
Curtis, Lauren E., APRN Curtis, Lauren E., APRN 860.972.3570
  • Cardiovascular Medicine
  • Hartford
Erwin, Susan, APRN Erwin, Susan, APRN 860.972.3570
  • Cardiovascular Medicine
  • Hartford
Hagberg, Robert Carl, MD Hagberg, Robert Carl, MD
4.9 /5
123 surveys
860.696.5520
  • Cardiac Surgery
  • Endovascular Surgery
Show Less
  • Hartford
Haider, Jawad, MD, FACC, RPVI Haider, Jawad, MD, FACC, RPVI
4.9 /5
32 surveys
860.242.8756
  • Interventional Cardiology
  • Cardiovascular Medicine
Show Less
  • Bloomfield
  • Hartford
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Hoover, Nicole Elizabeth, PA-C Hoover, Nicole Elizabeth, PA-C 860.972.3570
  • Cardiovascular Medicine
  • Hartford
Jumper, Robert Duva, MD Jumper, Robert Duva, MD 203.445.7093
  • Interventional Cardiology
  • Cardiovascular Medicine
Show Less
  • Trumbull
Lorenz, David Patrick, MD, FACC Lorenz, David Patrick, MD, FACC 203.845.2160
  • Interventional Cardiology
  • Cardiovascular Medicine
  • Endovascular Medicine
  • Internal Medicine
  • Vascular Medicine
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  • Norwalk
  • Bridgeport
Show Less
Piccirillo, Bryan James, MD Piccirillo, Bryan James, MD 860.972.3570
  • Interventional Cardiology
  • Cardiovascular Medicine
  • Internal Medicine
Show Less
  • Hartford
  • Norwich
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Piechota, Agnieszka Malgorzata, APRN Piechota, Agnieszka Malgorzata, APRN 860.972.3570
  • Cardiovascular Medicine
  • Hartford
Portnay, Edward Lowell, MD, FACC, FSCAI Portnay, Edward Lowell, MD, FACC, FSCAI 203.353.1133
  • Cardiovascular Medicine
  • Internal Medicine
  • Interventional Cardiology
Show Less
  • Stamford
  • Fairfield
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Pousatis, Sheelagh, MD Pousatis, Sheelagh, MD 860.696.5520
  • Cardiac Surgery
  • Hartford
Rizvi, Asad Ali, MD, FACC Rizvi, Asad Ali, MD, FACC
4.9 /5
47 surveys
860.972.5083
  • Interventional Cardiology
  • Cardiovascular Medicine
  • Echocardiography
  • Internal Medicine
  • Nuclear Cardiology
Show Less
  • Hartford
  • Norwich
Show Less
Sadiq, Immad, MD Sadiq, Immad, MD
4.7 /5
33 surveys
860.972.5083
  • Interventional Cardiology
  • Cardiovascular Medicine
  • Endovascular Medicine
  • Internal Medicine
  • Vascular Medicine
Show Less
  • Hartford
  • Norwich
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Squitieri, Rafael Paolo, MD Squitieri, Rafael Paolo, MD
4.8 /5
132 surveys
203.576.5708
  • Cardiac Surgery
  • Bridgeport
Thompson, Craig Alan, MD Thompson, Craig Alan, MD 860.524.3081
  • Interventional Cardiology
  • Cardiovascular Medicine
  • Endovascular Medicine
  • Internal Medicine
  • Vascular Medicine
Show Less
  • Hartford
Underhill, David Joseph, MD Underhill, David Joseph, MD
4.9 /5
54 surveys
860.696.5520
  • Cardiac Surgery
  • Endovascular Surgery
  • Vascular Surgery
Show Less
  • Hartford
Yaffee, David, MD Yaffee, David, MD
4.9 /5
97 surveys
860.696.5520
  • Cardiac Surgery
  • Cardiothoracic Surgery
Show Less
  • Hartford

Our TAVR Locations: