A Non Surgical Cutting Edge Technique For Aortic Stenosis

TAVI stands for Transcatheter Aortic Valve Implantation. It's a procedure that helps to improve a damaged aortic valve. During a TAVI Procedure, an artificial valve made of natural animal heart tissue (usually from a cow or a pig) will be implanted into your heart.

Transcatheter aortic valve implantation (TAVI) involves inserting a catheter into a blood vessel in your upper leg or chest and passing it towards your aortic valve. The catheter is then used to guide and fix a replacement valve over the top of the old one.

Transcatheter aortic valve implantation (TAVI) has evolved from novel technology to mainstream therapy in only a few years. In 2010, the first randomized trial was published, and in 2011, data from the Placement of Aortic Transcatheter Valve (PARTNER) cohort A were published. Since then, another randomized trial and several registries have reported the uptake of TAVI, both valve specific and country based.

You may feel overwhelmed if you have been recently diagnosed with severe aortic stenosis and this can make it harder to take the step toward treatment. But the sooner you seek care, the quicker you will be able to get back to life and all the things you love.

What is Aortic Stenosis?

Aortic stenosis is a common & serious valve disease problem. It is a narrowing of the aortic valve. The aortic valve allows blood to flow from the heart’s lower left chamber into the aorta and then to the entire body. Stenosis prevents the valve from opening properly, forcing the heart to work harder to pump blood through the valve. This causes pressure to build up in the left chamber and thickens the heart muscle.

Initially, your heart compensates the right pressure but after some time it won’t be able to keep up the extra effort of pumping blood through the narrowed valve. This can lead to heart failure.

Historically the treatment for this has been Surgical Aortic Valve Replacement; this requires long hospitalization and rehabilitation. But now this new therapy available that may help you get back on your feet faster. This is called TAVI, also called TAVR (transcatheter aortic valve replacement), and it is a less invasive procedure that is designed to replace a diseased aortic valve.

Initially, this procedure used to only be available for people who were too weak to undergo open-heart surgery. But now, TAVI is available for most patients.

How is it diagnosed?

Symptoms of aortic stenosis may include:

  • Breathlessness.
  • Chest pain (angina), pressure or tightness in the chest.
  • Fainting (temporary loss of consciousness caused by a fall in blood pressure), referred as “syncope”.
  • Palpitations or a feeling of heavy, pounding, or noticeable heartbeats.
  • Reduction in activity level or reduced ability to perform normal activities which require only mild effort.
  • Emergency and Rescue Procedures: Hypothermia/Intra-Aortic Balloon PumpThis is diagnosed by Echocardiography (2D Echo) on echocardiogram the Aortic leaflets may be thickened. With progressive stenosis the Aortic Valve area also reduces. The pressure of the valve is also increased (marker of severity). Aortic stenosis is graded mild, moderate and severe. Aortic valve replacement is only done for severe aortic stenosis.

What happens during TAVI?

This minimally invasive surgical procedure repairs the valve without removing the old, damaged valve. Instead, it wedges a replacement valve into the aortic valve’s place. The surgery may be called a transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI).

This procedure depends on your health and your doctor will decide what type of anaesthesia is best for you. You may be fully asleep, or you may be awake but given medication to help you relax and block pain. Your heart will continue to beat during the procedure. This is quite different from open-heart surgery, in which your heart will be stopped, and you will be placed on a heart and lung blood machine.

TAVI is different from open-heart surgery in that it uses a less invasive approach to treat a diseased aortic valve. Your doctor will determine the best approach for replacing your valve, but the most common technique involves a small incision made in the leg. This is called the transfemoral approach.

TAVI Procedure: step-by-step

A small incision is made in your upper leg. This is where your doctor will insert a short, hollow tube called a sheath into your femoral artery.

There are multiple different valves currently available. The type of valve required is individualized to the patient depending on the anatomy.

The new valve is then placed on the delivery system (or tube). The new valve is compressed to make it small enough to fit through the sheath.

The delivery system carrying the valve is pushed up to your aortic valve. Once it reaches your valve, the new valve pushes aside the leaflets of your diseased valve. Your existing valve holds the new valve in place.

The new valve will open and close as a normal aortic valve should. Your doctor will make sure your new valve is working properly before closing the incision in your leg.

Patients may feel relief from their symptoms soon after their TAVI procedure done, but others may take a little longer to get back to normal. Talk to the doctor about how long your recovery may take.

The patient only requires 2–3 days of hospitalization and is usually walking the next day. This cutting edge procedure is now available at Metro Hospital.