Frequently Asked Questions

TAVR stands for Transcatheter Aortic Valve Replacement.

Your cardiologist has placed a referral for TAVR because you have been diagnosed with Aortic Stenosis and that you may benefit from having it treated with TAVR. TAVR can also be performed for people who already have certain types of artificial heart valves if they stop working well, either by becoming narrowed or leaky.

• Aortic Stenosis is a common heart valve disorder that can range from mild to severe. Specifically, it is a condition caused by a narrowing of the aortic valve opening, leading to increased work of the heart muscle and abnormal blood flow out of the heart. Over time, this can cause heart failure, a progressive condition in which the heart can’t keep up with the body’s need for oxygen and blood flow. If left untreated, symptomatic aortic stenosis can lead to death. It most commonly affects older adults, but can also affect younger people.
• Symptoms of aortic stenosis include shortness of breath, fainting, dizziness, fatigue, leg swelling, chest pain/pressure/heaviness/tightness, and decreased stamina or exercise capacity.
• It is important to note that some of the symptoms could be related to another heart problem or something else altogether. Your doctors will use their expertise to recommend the best treatment for you. Occasionally, the TAVR team may recommend against treating a heart valve problem if we think that the risks are too high or that it will not help.

• Transcatheter aortic valve replacement (TAVR) is a less invasive surgical procedure to treat aortic stenosis. It is a newer alternative compared to traditional open-heart surgery (also known as Surgical Aortic Valve Replacement, or SAVR), which was first performed in 1967 and is still considered to be the preferred treatment in certain circumstances.
• In this procedure, a team of physicians use a series of wires and catheters to replace your heart valve with a prosthetic (tissue) heart valve. This TAVR valve is delivered to the heart through blood vessels in the legs, shoulders or neck. Once the new valve is in the correct position, it is expanded into place, pushing aside the patient’s faulty valve with the metal frame, effectively replacing it. The new TAVR valve begins functioning immediately, while the old valve serves as an “anchor” to hold the TAVR valve in place.

• TAVR is considered a minimally invasive procedure, meaning that rather than having open-heart surgery, the procedure is performed via a series of small punctures or incisions. This approach allows for a relatively shorter procedure time, hospital stay, and recovery time.
• The plastic tube or catheter to deliver the new valve is placed via a blood vessel that is large enough to accommodate it. It is most commonly placed via the femoral artery, the large blood vessel over the hip joint. However, TAVR can be performed by blood vessels in the neck, under the collar bone or through a small chest incision. In addition, there will be several smaller plastic tubes placed in other blood vessels to deliver medications, measure blood pressure, control the heart rate and take pictures (angiograms) to guide the procedure. Usually most of these tubes are removed before the patient leaves the procedure suite and the rest will be taken out during the recovery when they are no longer needed.

• Benefits of undergoing minimally invasive procedures include less trauma to body, improved pain control, shorter hospital stay, faster recovery time, and an overall improvement in quality of life.
• There may be specific considerations in your anatomy and/or other medical conditions that may favor either TAVR or traditional open-heart surgery. A team of experts, including interventional cardiologists and cardiac surgeons, will work together to determine the best treatment option for you.
• Since TAVR was first approved in 2011 to treat patients for whom heart surgery was considered too risky, it is increasingly being offered as an option to younger and healthier patients. However, it may not be the best treatment for all patients and since it is a newer therapy, there will be unanswered questions about long term outcomes for some time.

TAVR is a safe and established treatment for aortic stenosis, and in most recent clinical trials, the risk of complication is equal or lower than that of alternative treatments. However, it is important that anyone considering TAVR understands that there is a risk of a serious complication, which could be fatal or leave one with a permanent disability. Other possible risks of TAVR include, but are not limited to:

• The need for a new permanent pacemaker
• Bleeding or damage to a blood vessel
• Kidney damage, leading to need for dialysis
• Infection
• Heart attack
• Stroke
• Conversion to emergency open-heart surgery
• Death

Our goal is to ensure that you are as safe and comfortable as possible throughout the procedure. Most TAVR procedures do not require general anesthesia and are done with conscious sedation. You will be able to discuss the exact type of anesthesia required and any questions you may have with your anesthesiologist prior to your procedure.

On average, a TAVR procedure takes one to three hours. Most patients are able to go home the next day, but some stay up to three days.

Many patients feel better immediately, but recovery is variable. Most patients can walk the evening of their procedure, and patients usually can resume their daily routine within days to weeks of discharge.

• After your procedure, your doctor will likely recommend that you take some form of blood thinners, such as aspirin or clopidogrel (Plavix), while your body heals into your new heart valve.
• If you are currently taking blood thinners, you will likely continue to take the same type of blood thinners after your procedure.

Surgical bioprosthetic (tissue) valves tend to last between 10-15 years. TAVR valve materials are made from the same materials as these surgical valves; therefore, we anticipate similar durability from the TAVR valves. However, since TAVR is a newer procedure, at this time there are not sufficient data on the durability of these valves beyond seven years.

At the time of your consultation, you will have the opportunity to meet with our TAVR team of experts. This team includes interventional cardiologists, cardiac surgeons, cardiac anesthesiologists, imaging cardiologists, nurse practitioners, and nurse coordinators.

• Currently, there are two Kaiser Permanente locations that perform TAVR procedures- Kaiser Permanente San Francisco and Kaiser Permanente Santa Clara.
• The same team of doctors perform the procedure at both locations.
• Please notify us if you have a preferred location. However, please note that while we will do our best to accommodate your request, a variety of factors may influence the TAVR team’s decision to evaluate and treat you at a given location.

• The Kaiser Permanente Northern California Structural Heart / TAVR team is a small, dedicated group of physicians who have seen and treated patients at both locations since 2012. This group of physicians has successfully performed more than 1,000 TAVR procedures to date.
• Annually, the Kaiser Permanente Northern California Structural Heart / TAVR team performs more than 500 TAVR procedures, which ranks amongst the top 10 TAVR programs in the United States for annual procedural volumes.
• The TAVR procedure is also performed by a dedicated team of Kaiser Permanente physicians in the Greater Sacramento Region for patients in this area. Speak to your cardiologist if you would prefer treatment in this region.

Every TAVR procedure is performed with at least one interventional cardiologist, one cardiac surgeon, one cardiac anesthesiologist, and one imaging cardiologist. You will meet our team at your TAVR consultation.

Echocardiogram

• Aortic stenosis is often diagnosed via an ultrasound of the heart, called an echocardiogram. Echocardiogram is a non-invasive assessment of the heart which provides useful information on the heart valves and heart muscle function.

CT Angiogram

• Computed tomography (CT) is a non-invasive imaging study which provides severe useful pieces of information, including:
  • Valve selection and sizing
  • Access route (are the blood vessels in the leg large enough and healthy enough to perform TAVR or do we need to perform an “alternative access” approach from the neck or shoulder?)
  • Aortic arch anatomy (can we use the cerebral embolic protection device to potentially reduce the risk of stroke?)
  • Other high-risk anatomical features (calcium distribution, coronary artery heights, etc.)

Cardiac Catheterization / Coronary Angiogram

• Cardiac Catheterization is an invasive procedure using x-ray and contrast to visualize the arteries of the heart to see if there are blockages that require treatment prior to TAVR. Your cardiologist will arrange this procedure prior to your TAVR clinic visit. If possible, this procedure will be done at or close to your home Kaiser facility. In rare instances, a cardiac catheterization can be done after your TAVR clinic visit.

Dental Clearance

• Dental cleanings are among the most frequent sources of bacteria in the bloodstream. Patients with heart valve replacements are at high-risk for having bacteria in the bloodstream “stick on” their heart valve replacement and cause a potentially lethal infection, called endocarditis. Therefore, we request that all patients see a dentist and obtain dental clearance prior to proceeding with the TAVR procedure.
• If possible, please take this form to your dentist prior to your TAVR consultation. Ask your dentist to fill out the form and fax it back to us.

We recommend learning about TAVR before your consultation. This website, the FAQs, and your referring cardiologist hopefully can address many of your initial questions prior to your consultation. Any additional questions can be addressed at the time of your consultation with the TAVR team.

Kaiser Permanente Santa Clara

• Your consultation will take place at Kaiser Santa Clara Medical Office, 710 Lawrence Expy., Santa Clara, 95051, Department 342, 3rd floor.
• Free valet parking is available.

Kaiser Permanente San Francisco

• Your consultation will take place at Kaiser Permanente San Francisco Medical Center 2238 Geary Blvd., San Francisco, 94115, Cardiology Department, 8th floor.
• You may park underground of the Kaiser Permanente San Francisco Medical Center (2238 Geary Blvd, same building as your consultation). Then, go to the 8th floor and check in at the cardiology registration desk. We may partly validate your parking fee.

Yes, please bring whomever would make you feel comfortable, but please be aware that our exam space is limited. It is helpful to bring the person who will be helping you either before or after your procedure.

Please feel free to contact us at the following numbers:

• Kaiser Permanente Santa Clara: (408) 851-3709
• Kaiser Permanente San Francisco: (415) 833-6623 or (415) 833-6504