Transcatheter Procedures for Aortic Valve Disease

If you have aortic valve disease, your doctor at NYU Langone's Heart Valve Center may recommend minimally invasive procedures to repair a damaged valve.

Transcatheter Aortic Valve Replacement

If you have aortic valve stenosis and you are not a candidate for surgical aortic valve replacement, your NYU Langone doctor may recommend implanting an artificial aortic valve without removing the damaged valve. The valve is made from animal tissue and a metal mesh stent. 

Doctors at NYU Langone have helped pioneer the procedure, which is less invasive than traditional open surgery. The state-of-the-art procedure is known as transcatheter aortic valve replacement (TAVR), or transcatheter aortic valve implantation (TAVI). 

During the procedure, the doctor compresses the artificial valve and places it into a thin tube called a catheter, inserts it into the femoral artery through a tiny incision in the groin, and threads it to the aorta. The doctor places the artificial valve into the aortic valve, where it expands, pushing the damaged parts of the aortic valve out of the way. The new valve takes over the job of regulating blood flow to the aorta. 

This procedure is performed on people with aortic valve stenosis whose bodies can’t withstand traditional open heart surgery, or for those with conditions that could make surgery dangerous, such as diabetes or obesity. TAVR doesn’t require the heart to be stopped, so a bypass machine, which does the work of the heart and lungs during surgery, is unnecessary. 

Performed with sedation, TAVR typically requires a two-day hospital stay. Though people tend to feel better almost immediately after the procedure, the time required for recovery depends on how weak the body was before the procedure. 

Occasionally blockages in the femoral artery don’t allow doctors access to the aorta. If this happens, they may reach the aorta by making a small incision above the breastbone, called a transaortic approach. Or they may make an incision between the ribs in the left side of the chest. This is called a transapical approach.

TAVR may also be used when valves implanted during previous surgeries fail, in people who are too weak for open heart surgery. Our specialists can use a valve-in-valve procedure in which a valve made of animal tissue is placed directly in the failed surgical valve. It’s then anchored onto the damaged aortic valve to restore normal blood flow. 

Aortic Balloon Valvuloplasty

In aortic balloon valvuloplasty, which is performed under local anesthesia and, sometimes, sedation, doctors open the narrowed aortic valve with a special balloon. First, they insert a hollow wire into a blood vessel in the groin or arm through a catheter and then thread it to the aortic valve. The wire is guided by X-rays, and a contrast agent may be injected to help your surgeon view the aortic valve more clearly. 

Then doctors thread an expandable balloon at the end of the catheter through the vessel to the aortic valve, where it’s expanded to separate and stretch the valve’s leaflets. The balloon is then deflated and removed through the artery. The procedure requires an overnight stay in the hospital, and recovery takes a few days.

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