Post-TAVR Office Follow-Up
Patients after TAVR should be seen by the TAVR team at 30 days, by their primary cardiologist at 6 months and then annually, and by their primary care physician at 3 months and as needed thereafter, with echocardiography and ECG performed at 30 days and annually. 1
Follow-Up Schedule
Initial 30-Day Period
- TAVR team evaluation at 30 days is essential to diagnose and monitor any procedural complications 1
- Baseline echocardiogram and ECG must be obtained during this period to document valve function and any conduction abnormalities 1
- More frequent follow-up is warranted if there are changes in symptoms or transient conduction abnormalities 1
Long-Term Follow-Up Timeline
- Primary cardiologist at 6 months, then annually 1
- Primary care physician or geriatrician at 3 months, then as needed 1
- Coordination of care among the TAVR team, primary cardiologist, and primary care physician is critical 1
Antithrombotic Management
Standard Regimen
- Aspirin 75-100 mg daily lifelong 1
- Clopidogrel 75 mg daily for 3-6 months 1
- Consider warfarin (INR 2.0-2.5) if at risk for atrial fibrillation or venous thromboembolism 1
Important Caveat
Recent evidence suggests aspirin monotherapy may have similar efficacy to dual antiplatelet therapy with significantly reduced bleeding risk 2. However, the 2017 ACC guidelines remain the authoritative recommendation. In patients already on oral anticoagulation for atrial fibrillation or other indications, it is reasonable to continue low-dose aspirin but avoid additional antiplatelet therapy if possible to minimize bleeding risk 1.
Diagnostic Monitoring
Echocardiography
- At 30 days, then annually (if needed) 1
- Increase frequency if significant paravalvular leak or changes in clinical status occur 1
- Monitor for aortic regurgitation, which is typically paravalvular and mild in most patients 1
Electrocardiography
- ECG at 30 days and annually 1
- Consider 24-hour Holter monitoring if bradycardia is present 1
- Surveillance for conduction defects and heart block is essential 1
Laboratory Monitoring
- Blood counts, metabolic panel, and renal function should be monitored 1
- Assess pulmonary, renal, gastrointestinal, and neurological function annually or as needed 1
Management of Concurrent Conditions
Cardiovascular Comorbidities
The primary cardiologist should actively manage: 1
- Coronary artery disease
- Hypertension
- Heart failure (the most common cause of rehospitalization after TAVR) 3
- Arrhythmias, especially atrial fibrillation
Critical Pitfall
Heart failure decompensation is the leading cause of hospital readmission after TAVR and carries a negative prognosis 3. Multiple factors contribute including low flow status, cardiac amyloidosis, myocardial fibrosis, multivalvular disease, pulmonary hypertension, coronary disease, atrial fibrillation, significant paravalvular leaks, severe prosthesis-patient mismatch, and conduction disturbances 3. Close monitoring and optimization of medical therapy are essential.
Additional Care Elements
Endocarditis Prophylaxis
Lifestyle and Rehabilitation
- Promote cardiac rehabilitation and physical activity as appropriate 1
- Cardiac risk factor reduction and healthy lifestyle promotion 1
- Management of diabetes and dyslipidemia 1
Patient Education
- Provide comprehensive patient instructions and education at discharge 1
- Ensure patients understand warning signs requiring urgent evaluation 1
When to Intensify Follow-Up
Increase the frequency of follow-up evaluations for: 1
- Significant post-TAVR paravalvular leak
- Any change in clinical status
- Changes in echocardiographic findings
- New or worsening symptoms
- Transient conduction abnormalities