S .NO.

TOPIC TEACHER
SIGN
1 Certificate
2 Acknowledgement
3 What is TAVR?
4 Complications/Risks
5 Benefits/Advantages
6 Recovery
7 Frequently asked
questions(FAQ)
8 Statistical Analysis
9 Case study
10 Conclusion
11 Bibliography

INDEX
 CERTIFICATE

This is to certify that Antra Ashra of class

XI-C has successfully completed the
investigatory project on the topic
“Transcatheter aortic valve
replacement(TAVR)” under the guidance of
Mrs. Abha Sharma during the year 2022-
2023.

Mrs. Abha Joshi

(Biology teacher)
 ACKNOWLEDGEMENT

I would like to express my gratitude to my

teacher Mrs. Abha Sharma as well as the
principal who gave us this golden
opportunity to do this wonderful project on
the topic- TAVR. It helped me in doing a lot
of research about to the topic and helped me
gain knowledge about the topic. I would also
like to thank my parents and my friends who
helped me in finalizing the project within
the given time frame and provided me with
the necessary resources.
Yours thankfully
Antra Ashra
XI-C
 WHAT IS A TAVR
PROCEDURE?

Transcatheter aortic valve replacement (TAVR)

is a minimally invasive procedure to replace the
aortic valve in patients with severe aortic
stenosis. TAVR is less invasive than open heart
surgery, and the procedure typically takes one to
two hours. It is also known as percutaneous aortic
valve replacement. It can be done through very
small openings like femoral artery in the groin,
from the neck and a space between your ribs. The
doctor will guide a thin, flexible tube with the
heart valve into your artery and to your diseased
valve.

COMPLICATIONS
These are the 5 major complications-
1) PVL- Paravalvular leak
2) AKI- Acute kidney injury
3) AVB- Atrioventricular block
4) Bleeding
5) Stroke
6) May need a pacemaker. A possible
complication of TAVR is a disruption in
your heart’s electrical system. That usually
requires implanting a pacemaker.

BENEFITS/ADVANTAGES
-Low risk of infection and bleeding are lower
compared to traditional open-heart surgery.
-Speedy recovery
-Shorter procedure
-Having more energy
-Feel less anxious
-Breathing normally
RECOVERY
You can spend the night in the care unit
for a follow-up after your procedure. How long
you stay in hospital after the depends on
many factors. Some people who have TAVR go
home the next day. Before you leave the hospital,
your healthcare team will explain to you how to
care for any incisions and how to watch for them
and symptoms of infection. Warning signs of an
infection include fever, increased and redness,
swelling, discharge or oozing at the catheter site.
Several medications may be prescribed after
TAVI, including:
1) Blood thinners- Blood thinners are prescribed
to prevent blood clots. Your doctor will tell you
how long you need to take this medicine.
2) Antibiotics- Artificial heart valves
can be infected with bacteria. Most of the bacteria
that cause heart infections come from bacteria in
the mouth.

FREQUENTLY ASKED
QUESTIONS(FAQ’S)
Q1. How do I know if my tavr valve is working
properly?
A1-Your doctor will check your valve during your regular
follow-up visits. 

Q2. What kinds of exercise can I do with a tavr

valve?
A2- Discuss this with your doctor. He or she can help you
decide what activities are safe for you.
Q3. Is it safe to have an MRI with tavr heart
valve?
A3- If you need an MRI, tell your doctor that you have a
Medtronic TAVR heart valve. Not doing so could result in
injury or death.

Q4. Can the tavr valve be used for all patients?

A4- The Medtronic TAVR heart valve cannot be used for
patients who:
 Have an infection
 Cannot take blood thinners
 Have a reaction to some metals 

Q5. How long does a tavr last?

A5- Over 150,000 TAVR valves have been implanted over the
last decade worldwide and data regarding the durability of the
TAVR valves is accumulating. Of course this doesn’t tell us
about the non-survivors. For this reason, TAVR is not indicated
in relatively younger, non-high risk patients.

Q6. What determines whether I am a candidate

for a tavr procedure?
A6- Tavr is not suitable for everyone. Your heart team, which
may consist of your primary care physician, a cardiologist, and a
cardiothoracic surgeon will determine whether you are a
candidate. It is for those who are defined as high risk for
traditional open heart surgery, which is typically patients who
are over the age of 70 and have other medical conditions.

STATISTIC ANALYSIS
Background: In patients with severe aortic stenosis at increased
risk for surgery, self-expanding transcatheter aortic valve
replacement (TAVR) is associated with improved 2-year
survival compared with surgery.
Objectives: This study sought to determine whether this clinical
benefit was sustained over time (SAVR vs TAVR).
Methods: Patients with severe aortic stenosis deemed at
increased risk for surgery by a multidisciplinary heart team were
randomized 1:1 to TAVR or open surgical valve replacement
(SAVR). Three-year clinical and echocardiographic outcomes
were obtained in those patients with an attempted procedure.
Results: A total of 797 patients underwent randomization at 45
U.S. centers; 750 patients underwent an attempted
procedure. Adverse clinical outcome components were also
reduced in TAVR patients compared with SAVR
patients, including all-cause mortality, all stroke, and major
adverse cardiovascular or cerebrovascular events.
Conclusions: Patients with severe aortic stenosis at increased
risk for surgery had improved 3-year clinical outcomes after
TAVR compared with surgery. Aortic valve hemodynamics
were more favorable in TAVR patients without differences in
structural valve deterioration.

CASE STUDY
Presentation: In June 2016, a 97-year-old man presented
to the cardiology clinic symptoms of heart failure. After recently
being treated in the emergency department for similar symptoms
with intravenous diuretics. The patient had a long-standing
history of asymptomatic severe aortic stenosis and had been
highly functional until that day. Three years prior, he was denied
SAVR due to being considered a high surgical risk. A 2D
echocardiogram revealed a trileaflet aortic valve with a valve
area of 0.5 cm2 (normal is 3–4 cm2) and a mean transvalvular
gradient of 48 mmHg (normal is <5 mm Hg) which indicated
severe aortic valve stenosis. On assessment, his blood pressure
was 143/70 mm Hg, heart rate was 50 beats per minute,
respiration rate was 14 breaths per minute, and he was afebrile.

Preop Evaluation for Tavr- The patient was

admitted to the hospital emergently. His pre-operative risk
assessment for 30-day mortality was elevated at 14.4%, and he
was thus evaluated for TAVI. Multiple tests were performed to
assess the feasibility of the procedure. CT angiograms of the
thorax, abdomen, and pelvis were implemented to investigate for
abnormalities of the vasculature that would prohibit a trans
femoral approach for TAVI. Considering that stroke is a
common complication of this procedure, a carotid ultrasound
was performed to evaluate for carotid atherosclerosis. Two
cardiothoracic surgeons examined the patient and declared that
he would be at high mortality risk to have SAVR, and thus they
recommended TAVI. Cardiac catheterization was performed to
evaluate for coronary artery disease and to obtain hemodynamic
measurements.
Performance of Tavr- Under general anesthesia, the
right and left femoral arteries were each accessed with 6-french
sheaths. A temporary pacemaker was placed in the right
ventricle through an 8-french sheath in the right femoral vein.
Balloon valvuloplasty was performed by advancing a balloon
via the right femoral artery sheath, and during rapid ventricular
pacing at 160 beats per minute, inflating it across the aortic
valve to clear the stenosis and to deploy the 26-mm SAPIEN S3
bio prosthetic aortic valve shown in Fig. 1, which expanded
within the native aortic valve shown in Fig. 2. The purpose of
rapid ventricular pacing during TAVI is to reduce cardiac
output, which facilitates balloon inflation across the valve and
placement of the bio prosthetic aortic valve. The mean valvular
gradient after TAVI decreased to 1.9 mm Hg (normal is <5 mm
Hg). There were no intraoperative complications. The patient
was extubated and transferred to the coronary care unit with the
temporary trans venous pacemaker, which was removed two
days later.
Postoperative course- A 2D echocardiogram performed
on the first postoperative day showed that the prosthetic aortic
valve was well seated without any regurgitation. A 12-lead
electrocardiogram revealed new onset paroxysmal atrial
fibrillation with slow ventricular response (his heart rate was in
the range of 50 beats per minute). Anticoagulation treatment for
the prevention of thromboembolic events was initiated with
Apixaban 2.5 mg BID. The lower dose of Apixaban was
selected because he was older than 80 years and his serum
Creatinine level was above 1.5 mg/dL. In addition, Clopidogrel
75 mg daily was started to prevent stenosis of the bio prosthetic
valve. The patient was discharged home three days’ post
procedure.

Follow up visits- During the one-month follow-up

appointment with the primary care provider, the patient was
found to be severely bradycardic and became unresponsive for a
few minutes. He regained consciousness without any
resuscitative efforts and was taken emergently to the hospital.
An inpatient limited 2D echocardiogram showed normal systolic
function with ejection fraction of 55–60%. Unfortunately,
nothing was reported on the function of the bio prosthetic aortic
valve. The patient remained asymptomatic during the
hospitalization and was discharged home the next day. A review
of patient’s home medications revealed that he was taking the
negative medication, which may have precipitated his syncopal
episode. He was instructed to stop this medication.

During the six-month follow-up visit, the patient reported

continued symptomatic improvement. He had mild peripheral
edema. Dyspnea occurred with more significant exertion; thus,
NYHA functional class II. He remained off metoprolol as
instructed, and despite being bradycardic with a heart rate of 55
beats per minute, he did not experience any further episodes of
dizziness. A limited 2D echocardiogram revealed that the bio
prosthetic valve was well seated without any paravalvular leak.
The ejection fraction was 65% and he had mild diastolic
dysfunction. The patient was told to stop clopidogrel (as he had
completed the standard six-month treatment), and to continue
antiplatelet therapy with Aspirin 81 mg daily indefinitely.
Conclusion- As the life expectancy continues to rise,
especially in developed nations, and more individuals survive
into the tenth decade of life and beyond, there is a need for less
invasive treatments that add quality to longevity. TAVI is a
revolutionary approach to symptomatic severe aortic stenosis,
which carries a grim prognosis for those who do not qualify for
surgical valve replacement. The current case report of the 97-
year-old man demonstrates that it is never too late to push the
boundaries of medicine in the new millennium.

CONCLUSION
In 10 years we’ll have a TAVR valve for patients with aortic
insufficiency as well as those with a bicuspid valve. For
patients with an aneurysm in the aorta, we might have TAVR
endovascular stenting. In 20 years, the majority of aortic
disease patients will be treated with TAVR. TAVR patients
do so incredibly well. They are walking around right after the
procedure and discharged in three days. It’s a wonderful
option for patients.

BIBLIOGRAPHY
 https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC6371167/#sec2-geriatrics-02-00025title
 https://www.hopkinsmedicine.org/news/articles/a-
lower-risk-threshold-for-tavr
 https://healthblog.uofmhealth.org/heart-health/tavr-
vs-savr
 https://www.medtronic.com/us-en/patients/
treatments-therapies/transcatheter-aortic-valve-
replacement.html
 https://my.clevelandclinic.org/health/treatments/
17570-transcatheter-aortic-valve-replacement-tavr
 https://www.heart.org/en/health-topics/heart-valve-
problems-and-disease/understanding-your-heart-
valve-treatment-options/what-is-tavr
 https://www.healthgrades.com/right-care/aortic-
valve-replacement/recovery-after-tavr-what-to-expect
 https://www.jacc.org/doi/10.1016/j.jcin.2018.12.019
 https://www.mayoclinic.org/tests-procedures/
transcatheter-aortic-valve-replacement/about/pac-
20384698
 Google