Transcatheter Aortic Valve Implantation (TAVI)
Background
The aortic valve controls blood flow between the left ventricle and the aorta, the vessel that delivers oxygen-rich blood to the body. There are two main problems that can occur with the aortic valve: it can become hardened and narrowed (stenosis), or it can leak (regurgitation).
The most common problem in the elderly is called age-related calcific degeneration, where the gradual buildup of calcium causes the valve to narrow. Symptoms of aortic stenosis include lightheadedness, chest pain, shortness of breath and fatigue. In patients who are at high risk of complications in surgery, the aortic valve can be replaced by transcatheter aortic valve implantation (TAVI).
Transcatheter Aortic Valve Implantation (TAVI) - Maimonides Medical Center: https://www.youtube.com/watch?v=X1Uk9Jvbut0
About the surgery
At Adelaide Cardiothoracic we perform TAVIs as part of a “Heart Team”, which means that cardiothoracic surgeons, cardiologists, anaesthetists, geriatricians, and nursing staff are all involved in the decision regarding the best options for the patient and the patient’s care. The TAVI procedure is performed in a “Catheterisation Laboratory” with advanced imaging technology.
In TAVI, a biological (tissue) valve is mounted inside a stent (a circular wire mesh). The stent is then compressed so that it can fit inside a small delivery sheath (tube). The TAVI valve is then delivered to the aortic valve, the stent is expanded, and the biological valve inside begins to work. In TAVI, the calcified leaflets of the patient’s diseased aortic valve are not removed, instead, they are pushed to the side when the stent expands and help to lock the stent in place.
There are multiple ways of delivering the TAVI valve to the aortic valve position including:
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Transfemoral – preferred access site - A small three to four centimetre incision is made in the groin, and the delivery sheath and the TAVI valve travels upwards through the artery to the aortic valve.
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Subclavian - A small four to five centimetre incision is made just under the left or right clavicle, and the delivery sheath is inserted into the left subclavian artery which leads into the aorta.
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Transaortic – A small incision at the top of the sternum (breastbone) is made and the delivery sheath is inserted into the aorta (the large blood vessel that the aortic valve is in).
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Transapical – A five to ten centimetre horizontal incision is made on the left or right side of the chest below the nipple line, which provides direct access to the heart. The delivery sheath is then inserted into the apex or base of the heart and the TAVI valve inserted.
The “Heart Team” will assess you and decide what is the best approach to use. The transfemoral approach is preferred because it is minimally invasive, however, it is sometimes not possible. A transapical, transaortic or subclavian approach is then considered.
Recovery period
Patients usually stay in the coronary care unit for one to two days for monitoring before being able to go home. Full recovery usually takes about one to two months. Your surgeon will provide specific guidelines for your recovery and return to activities.
Risks of the surgery
Currently, TAVI is generally reserved for patients that are considered too high-risk for surgical aortic valve replacement. This is because it has been shown to be better than medical therapy, and the risk of death is lower than surgery in high-risk patients. However, the risk of stroke is slightly higher in TAVI.
There are a number of other specific risks, including a leak around the TAVI valve (paravalvular regurgitation), damage to the heart around the valve (aortic root injury), kidney injury, arrhythmias, and pacemaker implantation, bleeding and possibly death. As with all invasive procedures, there are also some general risks, including wound infection, and reactions to the anaesthetic.
All patients should consult their cardiothoracic surgeon for specific information about their medical condition and surgery.
For more information please visit:
Cleveland Clinic Transcatheter Aortic Valve Replacement (TAVR)