Percutaneous aortic valve replacement (patient information)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

What is PAVR?

Echocardiogram showing normal valvular function. The aortic valve is located at the top right of this image.

The job of the aortic valve is to keep blood flowing forward in one direction out of the heart. The arotic valve can leak and blood can flow backwards into the heart which increases the work the heart has to do or the valve can be narrowed making it harder for the heart to pump blood out of the heart. If either of these conditions is severe enough, the vavlve may require replacement. For years, this replacement of the valve has been done under general anestesia and has required that the ribs be broken to gain access to the heart to perform open heart surgery. Percutaneous aortic valvular replacement (PAVR) is a new less invasive procedure that does not require open heart surgery. In this procedure, a new replacement or prosthetic valve is implanted into the heart. The device is inserted through a small hole in the artery that runs to the leg . It is a relatively new procedure and is currently under study. It has the benefits of not requiring general anesthesia, causing less pain, less blood loss, and a lower risk of infection. There is also a faster recovery after PAVR than with traditional open heart surgery to replace the aortic valve.

Why is PAVR performed?

PAVR serves the same purpose as other forms of aortic valve replacement, such as surgical replacement. However, PAVR may be offered to patients who are not surgical candidates.

Aortic valve replacement may be done for a number of reasons, most commonly for aortic stenosis or aortic regurgitation. In aortic stenosis, the aortic valve does not open fully, restricting blood flow and causing extra stress to the heart. In aortic regurgitation, the valve does not close all the way, allowing blood to leak back into the heart. These conditions can be mild, not requiring valve replacement. In cases where the valve is severely damaged, is causing heart failure, or when there are significant symptoms of chest pain and shortness of breath, your health care provider may suggest aortic valve replacement. If you are not a surgical candidate, PAVR may be an option.

How is PAVR performed?

The PAVR procedure takes place in the catheterization lab. It is performed by inserting a balloon catheter into the femoral artery, which is in the groin area. The catheter, equipped with a compacted prosthetic aortic valve, is then directed into the heart chambers. The prosthetic valve is placed over the diseased aortic valve. The balloon is then inflated to fix the prosthetic valve in the desired position.

Risks and complications

As with all procedures, PAVR carries some risk. The most common risks would be infection and bleeding at the site where the catheter is inserted into the groin. Less commonly, other complications may result from a PAVR procedure:

• Leaking around the prosthetic valve (aortic regurgitation)
• Leaking around another heart valve, the mitral valve (mitral regurgitation)
• Tearing of the mitral valve
• Blockage near the opening of the coronary artery
• Breaking off of a piece of the prosthetic valve, causing decreased blood flow and possibly tissue death
• Shock

Related diseases

Several conditions can be treated with PAVR. These include severe aortic stenosis and aortic regurgitation as mentioned above. These two conditions can result from rheumatic heart disease and bicuspid aortic valve. Other conditions may also contribute:

• Endocarditis
• Myxomatous degeneration
• Valve trauma

Other images

• 

  Calcification narrows the opening of the aortic valve, producing aortic stenosis.

• 

  Myxomatous degeneration of the aortic valve weakens the valve's structure and can lead to valvular disease requiring replacement.

Sources

• "MedlinePlus Medical Encyclopedia: Aortic valve surgery - minimally invasive".