Cardiac Surgery | by Dr. Manoj Kumar Daga
A Transcatheter Aortic Valve Replacement (TAVR) or Transcatheter Aortic Valve Implantation (TAVI) is a surgical method performed to repair a compromised, blocked or narrowed artery which was causing disruption in the blood and oxygen supply to the heart. This surgical procedure is recommended for patients who have a higher risk or are too sick, or too old for open heart surgery. This breakthrough procedure is more advanced than a standard valve replacement. Where no other procedure guarantees long-term benefits, this procedure provides a statistically significant mortality rate and is regarded as a boon for people who were considered inoperable. It was in fact first tested in 2002 on patients with severe aortic stenosis (a narrowing of the aortic valve opening), who were considered unfit for open heart surgery. TAVI/TAVR outperformed in the trials with patients’ significantly better recording a higher mortality rate.
The Transcatheter Aortic Valve Replacement (TAVI/TAVR) procedure involves the implantation of the aortic valve via a catheter without removing the damaged, old valve. Instead, TAVI/TAVR wedges another valve into the aortic valve’s place (valve-within-valve). The approach is very similar to the placement of a stent – a stainless steel mesh – in the artery. In a TAVI/TAVR procedure, a small incision either through the upper chest or groin is made to place a small, hollow fine tube (sheath) that provides access to the aortic valve by placing a catheter mounted with a balloon. Once, the catheter is in place, the balloon is inflated at the termination point to push the plaque to the sides.
Once the compromised valve is opened, a completely collapsible valve (artificial, biological, or a combination of the two) in replacement, on the site of the old valve is placed through the catheter. Once, the placement is made, the new valve expands and drives the old one out of place, enabling the new tissue in the valve to become the primary medium of regulating blood flow in the heart. Post successful positioning, the balloon is deflated and removed.
Where a standard valve replacement surgery involves an open heart surgery by a sternotomy via a surgically opened chest, a TAVI/TAVR process is less invasive and involves small openings that do not harm the chest bones.
Transfemoral Approach: In this, the doctor enters through the large artery in the groin, without any surgical incision in the chest.
Transapical Approach: In this one, the doctor enters through the large artery in the chest by making small incisions on the chest.
This procedure reduces the symptoms of severe aortic valve stenosis – such as shortness of breath, chest pain, fainting, fatigue, heart palpitations, swelling in legs, etc. – and also increases chances of survival amongst people who have a high risk of surgical drawbacks/ failures or are considered high/intermediate risk patients for a standard valve replacement surgery.
While the surgery is less invasive, it is still very crucial to undertake proper precautions and follow accurate instructions to prepare for the surgery. The doctor might advise you to get some checkups done, ensure proper health, be mentally sure, and physically stable, and have family and friends to take care and support. The patient will need to shave off the hair from the area of insertion of the catheter, come to the hospital a day in advance, and ensure you consult your doctor about what foods to avoid and eat, any medications to take, or if you have any allergic reactions. The procedure is performed under local anesthesia.
Not only does a TAVI/TAVR procedure act as shining armor for a heart patient with no hope, it also has faster recovery time in general cases. In fact, the ease of performing, recovery time, and the process are as simple and equivalent to that of a coronary angioplasty or in some cases even a coronary angiography. In most cases, a patient is expected to recover within 3-4 days post a TAVI/TAVR procedure. During the recovery, the doctors will prescribe medicines and also follow up with tests and physical examinations.
That said, a TAVI/TAVR treatment has both benefits and risks involved. Some of the benefits include:
Though uncommon, these risks are important to be aware of before evaluating all options of treatment. Even the doctor will conduct several tests such as an ultrasound, echocardiogram, cardiac CT scan, and cardiac catheterization to determine if a TAVI/TAVR procedure is best suited to your condition.
Even after 20 years of existence, TAVI/TAVR procedure is continually being studied and advanced upon with newer techniques and refinements in technology and procedure, enhanced devices, post-operation care, newer approaches, and more.