Structural Heart: TAVR and Watchman Basics
What TAVR, Watchman, and related structural procedures do — who they’re for, and follow-up.
Learning Objectives
- 1.Understand TAVR and who it’s for.
- 2.Understand left atrial appendage occlusion (Watchman) and its role.
- 3.Know follow-up and complication concepts within scope.
Overview
Structural heart procedures are transcatheter treatments for valve and other structural disease. You’ll identify candidates, coordinate referral, and manage follow-up — the heart team performs and decides.
TAVR
- •Transcatheter aortic valve replacement treats severe symptomatic aortic stenosis.
- •A less-invasive alternative to surgical AVR; the heart team decides TAVR vs surgical AVR.
- •Identify severe symptomatic AS and refer for evaluation; manage post-procedure follow-up and meds.
Watchman / LAA occlusion
- •Left atrial appendage occlusion reduces AFib stroke risk for selected patients who can’t tolerate long-term anticoagulation.
- •It’s an alternative to lifelong anticoagulation in appropriate candidates — not a substitute for everyone.
- •There’s a post-implant antithrombotic protocol; confirm and coordinate.
Other structural (concept)
- •Transcatheter mitral repair (e.g., MitraClip) for selected severe mitral regurgitation; other transcatheter therapies exist — all heart-team decisions.
Scope
This is conceptual understanding for follow-up, complication recognition, and escalation. APPs do not perform these procedures, program devices beyond recognition/triage, or read raw images — those are the proceduralist’s/imager’s role.
Follow-up & complications
- •Post-TAVR: conduction disturbances (may need pacing), vascular/access complications, valve function follow-up.
- •Post-Watchman: device-related and antithrombotic considerations.
- •Recognize and escalate complications; manage the antithrombotic plan with the team.
Common beginner mistakes
- •Treating symptomatic severe AS as routine instead of referring for TAVR/AVR evaluation.
- •Assuming Watchman means no antithrombotic therapy (there’s a protocol).
- •Missing post-TAVR conduction problems.
Mini cases
An 82-year-old with severe symptomatic AS and high surgical risk.
Pathway?
Show answer
Refer to the heart team for TAVR evaluation — a less-invasive option well-suited to higher-risk patients with severe symptomatic AS. Don’t leave symptomatic severe AS on routine surveillance.
An AFib patient with recurrent serious bleeding who can’t safely stay on anticoagulation.
Option?
Show answer
Left atrial appendage occlusion (e.g., Watchman) is an option to reduce stroke risk in appropriate patients who can’t tolerate long-term anticoagulation — refer for evaluation.