From the Guidelines
No, TAVR (Transcatheter Aortic Valve Replacement) is not considered a revascularization procedure. TAVR is a minimally invasive procedure specifically designed to replace a narrowed aortic valve that fails to open properly (aortic stenosis) 1. It involves delivering a collapsible replacement valve to the heart through a catheter, typically inserted through the femoral artery in the leg. Revascularization procedures, by contrast, are interventions that restore blood flow to tissues by addressing blockages in blood vessels, such as coronary angioplasty, stenting, or coronary artery bypass grafting (CABG). These procedures treat different pathologies - TAVR addresses valvular heart disease by replacing a dysfunctional valve, while revascularization procedures treat vascular occlusive disease by reopening or bypassing blocked vessels. Although both types of procedures aim to improve cardiac function and blood flow, they target fundamentally different cardiac structures and pathologies, which is why TAVR is classified as a structural heart procedure rather than a revascularization procedure.
Some key points to consider:
- TAVR is recommended for patients with severe symptomatic aortic stenosis who are at high risk for surgical aortic valve replacement (SAVR) or are inoperable 1.
- The procedure has been shown to improve survival and reduce symptoms in these patients 1.
- TAVR is a distinct procedure from revascularization, with different indications and goals 1.
- The Heart Valve Team should evaluate patients for TAVR and consider factors such as coronary artery disease, left ventricular function, and pulmonary hypertension 1.
In terms of morbidity, mortality, and quality of life, TAVR has been shown to improve outcomes in patients with severe aortic stenosis who are at high risk for SAVR or are inoperable 1. However, it is not a revascularization procedure and should not be considered as such. The most recent and highest quality study, published in 2017, supports the use of TAVR as a structural heart procedure, rather than a revascularization procedure 1.
From the Research
Definition of Revascularization Procedure
A revascularization procedure is a medical intervention aimed at restoring blood flow to a specific area of the body, typically the heart, by removing or bypassing blockages in the blood vessels.
TAVR as a Revascularization Procedure
- TAVR (Transcatheter Aortic Valve Replacement) is a minimally invasive procedure used to treat severe aortic stenosis, a condition where the aortic valve narrows and restricts blood flow from the heart 2, 3, 4.
- While TAVR is primarily used to replace the aortic valve, it can also be considered a revascularization procedure in the sense that it improves blood flow from the heart to the rest of the body.
- However, TAVR is not typically considered a revascularization procedure in the classical sense, as it does not involve the removal or bypassing of blockages in the coronary arteries 5.
Relationship between TAVR and Revascularization
- Patients with severe aortic stenosis often have concomitant coronary artery disease (CAD), which may require revascularization procedures such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) 5.
- The management of CAD in patients undergoing TAVR is a topic of ongoing debate, with some studies suggesting that complete revascularization before TAVR may improve outcomes in selected cases 5.
- However, the decision to perform revascularization procedures in patients undergoing TAVR should be made on a case-by-case basis, taking into account individual patient characteristics and clinical presentation 5, 6.