Post-TAVR Management Recommendations
Post-TAVR management requires lifelong aspirin (75-100 mg daily), clopidogrel (75 mg daily) for 3-6 months, and coordinated care between the TAVR team, cardiologist, and primary care physician to optimize mortality and quality of life outcomes. 1
Immediate Post-Procedure Management
Access Site and Hemodynamic Monitoring
- Monitor access site carefully for adequate hemostasis and normal distal blood flow
- Watch for early signs of bleeding, hematoma, or pseudoaneurysm formation
- Follow institutional protocols for monitoring mental status, telemetry, vital signs, and volume status
Early Mobilization and Discharge Planning
- Encourage early extubation when general anesthesia is used
- Provide appropriate pain management
- Initiate early mobilization as soon as the access site allows
- Perform physical and occupational therapy assessment
- Early discharge (within 72 hours) is safe for selected transfemoral TAVR patients 1
Long-Term Follow-Up Schedule
Coordinated Care Team Visits
- TAVR team: 30 days post-procedure
- Primary cardiologist: 6 months and then annually
- Primary care physician: 3 months and then as needed
- More frequent follow-up for symptom changes or conduction abnormalities
Monitoring Protocol
- Echocardiography: at 30 days post-procedure, then annually
- ECG: at 30 days and annually
- Consider 24-hour ECG monitoring if bradycardia is present
- Regular laboratory monitoring: blood counts, metabolic panel, renal function
- Annual assessment of pulmonary, renal, GI, and neurological function
Antithrombotic Therapy
Standard Regimen
- Aspirin 75-100 mg daily (lifelong)
- Clopidogrel 75 mg daily for 3-6 months 1
Special Considerations
- For patients with atrial fibrillation or other indications for anticoagulation: follow guidelines for AF in patients with prosthetic heart valves
- Consider warfarin (INR 2.0-2.5) for patients at risk of AF or valve thrombosis 1
- Recent evidence suggests single antiplatelet therapy may reduce bleeding events without increasing thrombotic risk compared to dual antiplatelet therapy 2
- Among single antiplatelet options, clopidogrel monotherapy has shown lower cardiovascular mortality compared to aspirin alone in some studies 3
Management of Comorbid Conditions
Cardiac Conditions
- Hypertension: optimize blood pressure control
- Coronary artery disease: continue guideline-directed medical therapy
- Heart failure: manage according to current guidelines
- Arrhythmias (especially AF): monitor and treat appropriately
Non-Cardiac Conditions
- Pulmonary disease
- Renal disease
- Arthritis
- Frailty and cognitive impairment
Endocarditis Prevention
- Encourage optimal dental care
- Provide antibiotic prophylaxis according to AHA/ACC guidelines 1
Monitoring for Valve Complications
Valve Function Assessment
- Monitor for prosthetic valve dysfunction with regular echocardiography
- Assess for paravalvular regurgitation, stenosis, and leaflet calcification or thrombosis
- Long-term data shows excellent valve durability with low rates of structural valve deterioration (8.9% moderate and 1.3% severe) and bioprosthetic valve failure (3.8%) beyond 5 years 4
Conduction System Monitoring
- Watch for late-developing heart block or other conduction defects
- Consider more frequent ECG monitoring for patients with transient conduction abnormalities
Common Pitfalls and Caveats
- Readmission rates exceed 40% in the first year after TAVR, most commonly for non-cardiac causes
- Subclinical leaflet thrombus formation may be more common than previously recognized and may warrant consideration of anticoagulation in high-risk patients
- When using vitamin K antagonist therapy, continuing aspirin is reasonable but adding other antiplatelet therapy increases bleeding risk significantly
- The long-term durability of transcatheter valves is still being established, requiring vigilant monitoring
- Coordination between multiple providers is essential to prevent gaps in care or medication errors
Remember that TAVR patients are typically older with multiple comorbidities, requiring careful balance of therapies to optimize outcomes while minimizing adverse effects.