Transaortic Valve Implantation TAVI or Transaortic Valve Replacement (TAVR)
Transaortic Valve Implantation TAVI or Transaortic Valve Replacement (TAVR) is a minimally invasive interventional procedure for the treatment of aortic stenosis. Aortic stenosis is narrowing of the aortic valve. Aortic valve is 1/4 (one out of four) valves in the heart. A valve is nothing but similar to a door between two chambers. With age, these valves become degenerative and their valve opening starts to reduce, leading to narrowing of the valve.
The symptoms of aortic stenosis can range from dyspnoea or breathlessness, angina or chest pain and syncope. Once the patient starts developing these symptoms of Dyspnoea, angina and syncope, it attributes to the fact that the valve is severely stenosed and needs an urgent replacement. In a patient of severe aortic stenosis, TAVI or TAVR can be performed through the Femoral or / leg approach, where the valve is replaced through the artery in the leg and this opening in the artery is then closed by a small stitch.
TAVI or TAVR prevents an open-heart surgery for the same valve replacement. Thus, patients who have undergone previous open-heart surgeries either for coronary artery disease (triple vessel disease) or for any valve replacement (mitral/aortic) and thus are unfit to undergo a redo open heart surgery, TAVR/TAVI offers a good alternative. Also, patients in whom any other reasons for not being able to perform an open-heart surgery like any old cancer patients who have undergone radiation or frail old patients TAVI or TAVR can be performed.
TAVR / TAVI offers an approach due to which the risks of an open-heart surgery can be reduced to minimal and the valves can also be replaced providing adequate medical management to the patient.
Once the patient has been diagnosed with severe aortic stenosis, after a detailed echocardiography, the patient can be considered for TAVI/TAVR. Prior to the procedure the patient undergoes adequate lab investigations and a CPR program which helps us decide the size and the type of valve.
A heart team meeting which includes an Interventional Cardiologist, a Cardiothoracic Surgeon, Cardiac anaesthetics and all Cath lab technician is held to decide the steps of the procedure, the valve, the size of the valve and the post-operative care.
The valve is passed through the leg or the femoral artery right into the aorta and from the aorta in through the aortic valve, it is done placed that the aortic valve over the existing native valve. Once this procedure is done the small opening in the femoral artery is closed by small stitch and the patient is shifted to an intensive cardiac unit. The patient’s stay in Intensive Care units for a day or two and is mobilized as soon as possible. The benefits of this procedure are not only short Hospital stay, faster mobilization but also the patient does not need to take any blood thinners (Anti coagulants) for the same on a long-term basis. Considering the various benefits, TAVR or TAVI has become one of the most important cardiac procedures in patients who are not fit to undergo open heart surgery.