If you have aortic valve stenosis and your doctor has mentioned the TAVR procedure, you likely have some questions. Starting with: What's that?

"TAVR stands for transcatheter aortic valve replacement," says Dr. Clifford Kitten, a heart surgeon at Houston Methodist. "When the aortic valve narrows to the point of not fully opening, we need to fix it. And TAVR is one of those ways."

The other is through open surgery, a procedure called SAVR (surgical aortic valve replacement). It's a big operation, which, until recently, was the only aortic stenosis treatment option available to the majority of people who require aortic valve replacement. Even just 10 years ago, most aortic valves were repaired surgically.

"That's all changed in the last five years as the procedure and valves have improved," says Dr. Kitten. "It's now widely used throughout the U.S. and the world."

As of this past year, TAVR is now used more frequently than SAVR.

What is TAVR?

First, a definition is probably in order. The transcatheter part of TAVR means that the aortic valve is fixed via needle punctures and tiny tools that fit inside a catheter — rather than by opening the chest and being placed on a heart-lung machine, as is the case with SAVR.

"We needed an option like this to take care of patients for whom the risk of undergoing open surgery is just too great," explains Dr. Kitten. "The only real solution to aortic valve stenosis is to repair the valve. So, before TAVR, we didn't have an option for these patients, beyond trying different medications to relieve symptoms for as long as we could."

The TAVR procedure is far less invasive than SAVR, making it less risky. It also shortens the length of hospital stay and overall recovery time.

"The name is actually a little misleading in that we don't actually replace the damaged valve," explains Dr. Kitten. "We simply implant a new one that pushes the old valve against the wall of the aorta and out of the way. It's why, in the literature, this is actually referred to as transcutaneous aortic valve implantation, TAVI, instead."

With a new valve that can open and close properly in place, normal blood flow is restored — from the aorta to the heart and rest of the body.

Who qualifies for the TAVR procedure?

When TAVR was introduced some 20 years ago, it was designed for very weak and elderly people who couldn't undergo a complicated surgery. Now, TAVR is available to almost anyone who requires aortic valve replacement.

"TAVR valves have improved over time, as have the percutaneous and implantation techniques needed to deliver and place them," explains Dr. Kitten. "The procedure has advanced to the point that it's no longer restricted to just high-risk patients."

Most people now qualify for TAVR, but there are a few caveats to this.

"Even with the improvements to TAVR valves, they still deteriorate over time," adds Dr. Kitten. "This means young, low-risk individuals may benefit from the longer-lasting metal valves that can be placed via SAVR."

There's no upper age limit for the procedure, as evidenced by Dr. Kitten recently performing TAVR on a 101-year-old man.

Anatomy, however, can be a barrier. A clear path is required to deliver the valve without damaging the artery along the way.

"Some people have disease in all areas of the cardiovascular system, including extensive narrowing of the arteries," explains Dr. Kitten. "Occasionally, we can't find a clear artery to navigate through and can't consider TAVR."

What should you expect during a TAVR procedure?

To be eligible for TAVR, an extensive work up is needed.

"We have to make sure the procedure is going to work, so we assess each patient using various tests — echocardiograms, CT scans, cardiac catheterization," Dr. Kitten lists. "The results are reviewed during a joint conference and, as a team, we have to agree the procedure is going to be successful."

TAVR is performed in an operating room, under general anesthesia or local anesthesia with heavy sedation.

"A puncture is made in the groin, an arm or the neck to reach an artery. The preference is to enter through the groin, but we can use any of these access points," explains Dr. Kitten. "We then insert the catheter, guide it to the aorta and implant the valve once we reach the right position."

A few other small punctures and tools are used to control blood pressure and heart rate during implantation. The procedure is finished using percutaneous closure devices, making it entirely minimally invasive.

"Patients recover in the ICU overnight," says Dr. Kitten. "They go home the next day and are able to get around like usual, and they're typically back to their normal selves after 10-14 days."

Driving is restricted for a week, while strenuous activity and heavy lifting are restricted for two weeks.

Will TAVR help shortness of breath and other aortic stenosis symptoms?

Some of the most noticeable aortic valve stenosis symptoms include:

• Chest pain
• Shortness of breath, especially with activity
• Feeling dizzy and even fainting
• Fatigue, especially after being active

"As the problem progresses, people have a hard time doing things as simple as walking around the house without getting short of breath," says Dr. Kitten.

The TAVR procedure can help alleviate all of these symptoms.

"The elderly man I recently worked on even told me he was excited to go dancing on his upcoming 102nd birthday," adds Dr. Kitten.

How long will a TAVR valve last?

Believe it or not, the aorta is about the same diameter as a garden hose. This means the artificial valve placed during repair must be large enough to fit that space.

"When we're opening the chest to implant a new valve, we can place a metal device that large," says Dr. Kitten. "And these metal valves last the person their entire life."

TAVR valves don't last that long.

"When delivering a valve via an artery, which is about the diameter of a ball-point pen, the material needs to be something that can be compressed during delivery and then easily expanded once we get it into position," explains Dr. Kitten. "There is a metal scaffold on the outside to provide support, but the actual valve delivered via TAVR is made of bovine tissue."

The downside of using biological tissue is that it comes with a deterioration rate, usually around 1%-2% per year. This means a TAVR valve may need to be replaced as early as 10 years after the procedure.

"For some patients, this isn't a concern due to their age at the time of repair," says Dr. Kitten. "But for younger people — those who are 60 and younger — they'll need to seriously consider whether they want to undergo another procedure in the future before deciding on TAVR."

Which is better: TAVR or SAVR?

As far as the best way to fix aortic stenosis, current studies put SAVR and TAVR on fairly equal footing. This wasn't always the case but, as TAVR valves improved, the procedure is now comparable to SAVR in terms of effectiveness.

"There are pros and cons to each, of course," says Dr. Kitten. "It's information that your doctor will discuss with you when presenting the options."

SAVR is a big, complex procedure, but the metal valve placed should last the person forever. TAVR is less invasive and shortens recovery, but the valve placed comes with an "expiration" date.

The decision of which to choose is sometimes up to the individual, sometimes the doctor's call.

As mentioned, surgery isn't always an option for elderly, frail individuals. But Dr. Kitten notes that he might recommend TAVR over SAVR to someone who is under 60 and has multiple medical problems, an example of when choosing a less risky procedure is prioritized over preventing the need for a future one.

"And then some of my young, healthy patients — who would benefit most from the one-and-done nature of repairing a valve using SAVR — they don't want to undergo such a big operation," says Dr. Kitten. "They're OK with needing to have another procedure 20 or 30 years down the line."

Anyone considering TAVR should work with their doctor to make sure they have all the information needed to seriously consider which option is best for them, specifically.

Are TAVR valves MRI safe?

Many metal used in common medical devices are magnetic and thus are not safe in MRI machines. TAVR valves contain some metal but pose no danger in MRIs.

"TAVR valves are MRI compatible," says Dr. Kitten. "Patients do not need to worry about being in an MRI machine after their TAVR procedure."

Occasionally, a person may need a pacemaker — which is not MRI safe — after valve replacement, but this is rare and will be clearly explained if that's the case.

"The main point I do like to drive home with my TAVR patients is that this is an artificial valve, so there may be times when steps need to be taken to protect the valve from infection," explains Dr. Kitten. "Any time someone is doing something that breaks a skin or mucosal barrier — having a tooth pulled, getting stitches after a fall — let them know that you have an artificial valve and to cover you with antibiotics to help prevent infection."