Skip to main content
Cardiolucent

Treatment

Valve Repair or Replacement (TAVR, Surgical)

Transcatheter and surgical options for severe valve disease.

Significant valve disease — most commonly severe aortic stenosis or severe mitral regurgitation — eventually requires mechanical correction once medications and lifestyle can no longer compensate. Modern options include transcatheter aortic valve replacement (TAVR) for aortic stenosis, transcatheter edge-to-edge repair (TEER, MitraClip) for selected mitral regurgitation, and surgical repair or replacement performed through traditional or minimally invasive approaches. The right choice depends on valve anatomy, surgical risk, life expectancy, and patient preferences. Decisions are made by a heart team that includes interventional cardiology, cardiac surgery, imaging, and the longitudinal cardiologist. Dr. Kedan evaluates timing and coordinates the heart team review through Cedars-Sinai.

What This Treatment Approach Includes

  • Serial echocardiography to track valve severity, ventricular function, and chamber sizes
  • Symptom assessment including exercise testing when symptoms are ambiguous
  • Pre-procedure imaging: TEE, cardiac CT, sometimes cardiac MRI
  • Heart team review at Cedars-Sinai — interventional, surgical, imaging, and clinical cardiology
  • Choice between TAVR, surgical replacement (mechanical or bioprosthetic), or TEER/repair
  • Pre-procedure optimization of heart failure, anticoagulation, and comorbidities
  • Post-procedure rhythm monitoring, anticoagulation planning, and cardiac rehabilitation

How It Works

TAVR involves advancing a folded bioprosthetic valve through a catheter (typically from the femoral artery), positioning it within the diseased aortic valve, and expanding it to take over function — without opening the chest. Surgical valve replacement removes the diseased valve and sews in a mechanical or bioprosthetic replacement through a sternotomy or minimally invasive incision. Mitral repair preserves the native valve using sutures, rings, or transcatheter clips (TEER), which is often preferred over replacement when feasible because it preserves ventricular function better.

Who This Is For

  • Severe symptomatic aortic stenosis — TAVR or surgical AVR based on anatomy and risk
  • Severe asymptomatic aortic stenosis with reduced ejection fraction or abnormal stress response
  • Severe symptomatic mitral regurgitation — surgical repair preferred when feasible
  • Severe functional mitral regurgitation despite optimized heart failure therapy — TEER candidate
  • Severe mitral stenosis — surgical or percutaneous balloon valvuloplasty in select rheumatic disease
  • Severe tricuspid regurgitation in select patients (emerging transcatheter options)
  • Bioprosthetic valve degeneration requiring redo procedure — increasingly addressed with valve-in-valve TAVR

Monitoring and Follow-Up

Post-procedure follow-up includes baseline echocardiography, rhythm monitoring (especially after TAVR, where new conduction system disease can develop), anticoagulation management based on valve type, and cardiac rehabilitation enrollment. Bioprosthetic valves are followed with annual echocardiography to detect early degeneration; mechanical valves require lifelong warfarin with INR monitoring. Dr. Kedan provides the longitudinal follow-up, with same-day access for symptoms or rhythm concerns in the post-procedure window.

How Cardiolucent Manages This

Timing of valve intervention is one of the most consequential decisions in valve disease — too early adds procedural risk without symptom benefit, too late allows irreversible ventricular damage. Dr. Kedan tracks valve severity and symptoms over time, coordinates the heart team review at Cedars-Sinai at the right moment, and remains the continuity cardiologist before, during, and after the procedure. Extended visits make the shared decision-making thorough, particularly around mechanical versus bioprosthetic valve selection in younger patients.

Common Questions

Frequently Asked Questions

What is TAVR and how is it different from surgery?
TAVR (transcatheter aortic valve replacement) is a catheter-based procedure that places a new aortic valve through a catheter inserted in the femoral artery, without opening the chest or stopping the heart. Surgical aortic valve replacement removes the diseased valve and sews in a replacement through a sternotomy or minimally invasive incision. TAVR has shorter recovery; surgery has longer-track-record durability data, especially in younger patients.
Who is a candidate for TAVR?
TAVR was originally approved for high-risk and inoperable patients but is now indicated across the surgical risk spectrum — including low-risk patients — for severe symptomatic aortic stenosis. The choice between TAVR and surgery depends on age, anatomy, valve type expected to last longest, presence of other cardiac surgery needs, and patient preference. The heart team makes the recommendation.
What is the difference between a mechanical and a bioprosthetic valve?
Mechanical valves are made of durable materials (carbon, titanium) and typically last decades, but require lifelong anticoagulation with warfarin (DOACs are not appropriate). Bioprosthetic valves are made from animal tissue, do not require lifelong anticoagulation, but degenerate over 10 to 20 years. The choice depends largely on age, anticoagulation tolerance, and patient preference.
When should severe aortic stenosis be treated?
Once severe aortic stenosis becomes symptomatic — exertional shortness of breath, chest pain, syncope, or fatigue — survival drops sharply without intervention. Some asymptomatic patients also warrant intervention based on reduced ejection fraction, abnormal stress test response, very high gradients, or rapid progression. Symptom-driven timing requires honest reporting and serial assessment.
What is mitral repair versus replacement?
When the mitral valve can be repaired (typically degenerative disease with prolapse), repair preserves the native valve and is associated with better long-term ventricular function. Replacement is required when repair is not feasible. Functional mitral regurgitation from heart failure has different options, including TEER (MitraClip) for selected patients on optimized medical therapy.
What is the recovery like for TAVR versus surgery?
TAVR patients typically go home within 1 to 3 days and resume normal activity within a few weeks. Surgical valve replacement requires several days in the hospital and several weeks of recovery, with restrictions on lifting and driving. Both benefit from cardiac rehabilitation enrollment.
What are the main risks?
All valve procedures carry risks including stroke, bleeding, infection, conduction system damage that may require a pacemaker (particularly with TAVR), kidney injury, vascular complications at access sites, and rarely death. Risks are individualized to your anatomy, comorbidities, and procedure type. The heart team reviews specifics in detail.
Will I need anticoagulation after the procedure?
Mechanical valves require lifelong warfarin. Bioprosthetic valves typically require shorter-duration anticoagulation or antiplatelet therapy, with longer-term aspirin in some cases. TEER patients often continue on prior antithrombotic regimens. Dr. Kedan manages the long-term plan.
What lifestyle changes matter after a valve procedure?
Cardiac rehabilitation is recommended for nearly every patient and significantly improves outcomes. Endocarditis prevention with appropriate antibiotic prophylaxis before certain dental and surgical procedures applies to prosthetic valves and repaired valves with prosthetic material. Regular aerobic exercise, Mediterranean diet, blood pressure and cholesterol control, and tobacco cessation all matter long-term.
How do I start a valve evaluation with Dr. Kedan?
Schedule a consultation at the Beverly Hills office with prior echocardiograms, imaging, and current symptoms. Cardiolucent is a concierge practice and does not bill Medicare or insurance, though a detailed superbill is provided for out-of-network reimbursement. The procedure itself is performed at Cedars-Sinai. Call (310) 304-5555 or use the contact form.

Explore

Related Treatments

Evaluating valve repair or replacement?

Discuss this treatment with Dr. Kedan in Beverly Hills.
Schedule an Appointment

Medical Disclaimer

The information on this site is for general educational purposes only and is not medical advice, diagnosis, or treatment. Reading this site does not create a doctor–patient relationship. Always consult a qualified healthcare professional for personal guidance. If this is an emergency, call 911. Mentions of medications, devices, or procedures are informational and not endorsements. Full medical disclaimer.

†Some listed indications involve investigational/off-label use. Learn more.