Transcatheter Aortic Valve Implantation (TAVI)

Transcatheter Aortic Valve Implantation (TAVI)

 

Overview

A failing aortic valve is replaced with an artificial one during transcatheter aortic valve implantation (TAVI), also known as transcatheter aortic valve replacement. This operation replaces a heart valve less invasively than the conventional open-heart surgery approach. As a result, TAVI is frequently chosen for patients who are at high risk for surgical problems, even though it is still a major procedure with potential risks. Additionally, TAVI is increasingly being considered for patients who don't have these preoperative concerns.

 

TAVI

TAVI

A transcatheter procedure is a kind of surgery in which the surgical site is reached by threading a catheter (a small tube) through a blood vessel through a small skin cut. An expandable prosthetic valve comprised of metal and animal tissue is implanted into the heart as part of an aortic valve replacement. If you undergo TAVI, your surgeon will advance the prosthetic aortic valve through a catheter to the aorta before inserting it into its final place.

The main artery in your body, the aorta, comes directly from your heart. From the heart, its branches distribute oxygen-rich blood to the rest of your body. The aortic valve, which is made up of several tissue cusps, is positioned between the heart and aorta and helps in regulating blood flow between the two. Your TAVI would be carried out by a heart surgeon or interventional cardiologist. Your cut will either be in your chest (under general anesthesia) or in your groin (under sedation and monitored anesthesia).

 

TAVI Indications

TAVI indications

A damaged aortic heart valve is replaced with TAVI rather than repaired. The cusps of the aortic valve do not move as they ought to when it has calcification damage. Aortic regurgitation (when blood flows back into the heart from the aorta) and/or aortic stenosis (when the aortic valve does not fully open, making it more difficult for the heart to eject blood into the aorta) may result from this.

The prevalence of aortic valve disease increases with aging. It may result in fatigue, an inability to do strenuous activity, syncope (fainting spells), chest pain, and congestive heart failure. If untreated, the condition could deteriorate to the point where it poses a threat to life. Aortic valve replacement can reduce aortic valve disease symptoms and perhaps increase lifespan.

Your doctor may suggest TAVI as a less physically demanding option to open heart surgery and cardiopulmonary bypass for replacing the aortic valve. A transcatheter surgery often has a quicker recovery time while still posing the same surgical complications risk.

 

TAVI Contraindications

If your health is extremely fragile or if you have minor aortic valve disease, you might not be a candidate for TAVI. If you have organ failure (such as kidney failure or pulmonary failure), you run a high risk of suffering surgical complications or passing away during this treatment. This can make TAVI less beneficial for you and more dangerous. Additionally, this procedure may raise your risk of dying if you have a life expectancy of less than a year (for example, if you have end-stage cancer).

 

TAVI Preparation

TAVI Preparation

You will receive an evaluation of your aortic valve before TAVI. With the use of echocardiography, your surgeon will most likely examine the structure and motion of your aortic valve in addition to the way your heart beats. Before your surgery, measurements of the valve and aorta will be made. To evaluate the size and patency (level of opening) of blood vessels that will be accessed throughout surgery, you will also have an ultrasound examination. An electrocardiogram (ECG), a chest X-ray, blood chemistry tests, and a complete blood count (CBC) will all be performed before surgery.

You will drive from home to the hospital for your procedure, and you will stay there for at least one night following it. Your surgery will be carried out in an operating room or procedure suite at the hospital. You can arrive at your surgical appointment in whatever comfortable. During a TAVI, you must put on a hospital gown. You must abstain from eating and drinking after midnight the night before your surgery if you are receiving general anesthesia.

You might also need to modify your diet in advance of your surgery if you are receiving monitored anesthetic sedation; inquire with your surgeon's office for their exact instructions. If you use any blood thinners or medications to treat heart disease, your doctor will advise you on whether to modify the dosage.

Make sure your doctor is informed about all the drugs and supplements you take, including prescription, over-the-counter, herbal, and recreational ones. Bring your ID and insurance details with you to your surgery appointment. You should bring payment if you will be paying for any portion of your surgery. Bring whatever you will need for your hospital stay, such as extra clothing and toiletries. Any valuables should stay at home. When you are discharged from the hospital, you should have a driver for you. Your healthcare professional may suggest that you stop smoking before surgery because it can impair healing.

 

TAVI Procedure

TAVI Procedure

 

Before the Surgery

You will need to register and complete a consent form before having surgery. Then, a staff member will accompany you to the pre-operative area so you can put on a hospital gown. You might undergo testing the same day, such as a CBC, blood chemical analysis, and urinalysis. A urinary catheter may be inserted either before or after you enter the operating room. an IV line that is inserted into a vein in your arm or hand. Your temperature, blood pressure, heart rate, respiration rate, and oxygen saturation will all be checked.

 

During the Surgery

When you enter the operating room, a surgical drape will be put over your body, exposing and cleaning the region of skin where your cut will be made. An IV injection will be used to begin your anesthesia. In the case of general anesthesia, the drug will make you unconscious, and a breathing tube will be inserted in your throat to help you breathe during the procedure. A sedative will be given into your IV to put you to sleep for monitored anesthetic sedation, and a local anesthetic will be injected into the skin close to the incision site.

Your procedure will start with a tiny incision (less than an inch in length) made by your surgeon. Your femoral artery can be accessed through an incision in your groin, or your subclavian artery can be accessed through an incision between your ribs.

Through the skin incision, the catheter is inserted into the artery. The catheter and replacement valve are moved through the blood arteries under imaging guidance until they reach the aortic valve.

A little package that can be inserted via the blood vessel with the catheter and the artificial valve inside it has been produced. The new valve is deployed once it is in position, enabling it to fully open.

The replacement valve is often positioned above the old, unhealthy aortic valve so that it can take up the role of regulating the flow of blood out of the heart.

Even though atherosclerotic plaque may be excised from the valve tissue, the damaged valve is normally left in place. The new TAVI valve will be placed inside the old valve if you have previously had an artificial valve implanted.

Your surgeon will use imaging tests to monitor the replacement valve's function once it has been placed correctly. The catheter will be withdrawn if the placement is accurate and the valve is operating appropriately. Before the catheter is withdrawn, any necessary modifications will be made. Your skin will be dressed surgically after the blood vessel and skin incisions have been sutured closed.

Anesthesia will be stopped or reversed after the surgery is finished. Your anesthesia team will check that you are breathing well on your own before removing any breathing tubes you may have had during surgery.

 

Postoperative Care

You will start to regain consciousness in the recovery area. You might experience some blurriness. The medical staff in the recovery room will assist you with walking and administer painkillers as necessary.

During your hospitalization, an ECG and pulse oximetry will be used to monitor your heart function and oxygen saturation, respectively. You will also have your respiratory rate, pulse, and blood pressure checked. Your medical team will look at your surgery wound and advise you on how to take care of it at home.

You might have some of your cardiac medications, like your blood pressure medication, adjusted while you are recovering. To prevent blood clots, you will be given blood thinner medication while you are in the hospital as well as a prescription for blood thinning medication to use at home. Additionally, you can be given a prescription for painkillers to use at home. You will be let go within a day or a few days.

 

TAVI Recovery

TAVI Recovery

As you heal from your valve replacement, you should feel at ease. Within days of your surgery, you can start to feel more energized than you did before.

Take it easy nevertheless while your wound heals and up until your doctor assesses your heart function. Avoid physical labor-intensive activities like pushing, tugging, or heavy lifting while driving. Although your valve replacement will undoubtedly resolve some of your heart function problems, you might still be limited by an unresolved heart condition.

Your wound will be checked, the sutures will be removed, and your cardiac function will be assessed at follow-up visits with your healthcare professional.

The brief incision used in TAVI should close up in about a week. Your doctor could advise that you start cardiac rehabilitation if you already have heart problems (such as heart failure) before having your valve replaced.

 

Coping with Recovery

Coping with Recovery

You might have to adjust to taking new drugs while you are healing. You need to take extra precautions to prevent injury because blood thinners can make you more prone to bleeding.

For the treatment of heart failure or high blood pressure, you can also be taking brand-new drugs or change the doses of your current ones. If you have any side effects from these medications, such as dizziness, shortness of breath, fatigue, or palpitations, be sure to keep in touch with your healthcare professional.

Some patients who had low appetites before the procedure may experience a decrease in appetite following TAVI. According to research, nutritional deficiencies may prevent a good recovery. Discuss your dietary consumption with your healthcare provider so that you can get the dietary supplements you require for treatment.

 

TAVI Risks

Risks of TAVI

TAVI involves the same risks as any surgical treatment or general anesthesia. There are certain additional risks associated with this procedure. The following are potential side effects of the TAVI procedure:

  • Stroke after surgery
  • Heart attack
  • Blood clots
  • Bleeding at the site of the cut
  • Infection at the site of the cut
  • An injury to the heart during the procedure
  • Arrhythmia (abnormal cardiac rhythm)
  • Endocarditis (infection of the valve)

After-heart surgery complications can be extremely serious and even fatal. For the first day following your procedure, you will be closely watched in the hospital so that your medical professionals can spot any early warning signals of issues.

 

Long-term Care After TAVI

Long-term Care After TAVI

If you have other conditions like atherosclerosis, hypertension, heart failure, or arrhythmia, you will still need to take efforts for a healthier heart after TAVI. Although a heart valve replacement can significantly improve your health, it doesn't solve all heart issues. Medications and lifestyle changes are typically used to treat heart disease.

For as long as your valve is in place, you must continue taking blood thinner medication as prescribed by your doctor. Additionally, you will require routine cardiac function monitoring, which may involve an ECG and echocardiography.

You could be at risk of getting endocarditis after having a heart valve replaced. To prevent infection during dental procedures, you should let your dentist know if you have an artificial heart valve. If the details of your risk need to be referred to in a healthcare setting, you might also think about carrying a card offered by the American Heart Association.

 

Lifestyle Modifications

Overall, you ought to feel better than you did before your TAVI. The danger of bleeding as a result of blood thinners is the most crucial adjustment to take into account. This may not always be a change for you as you may have been taking blood thinners for years before your TAVI procedure.

You should avoid activities that could result in serious falls, like hiking or climbing on uneven ground, because of the possibility of bleeding. If you have poor balance, you may even need to take extra precautions when biking or climbing and descending stairs. Future cardiac problems can be avoided by remaining active, eating a low-cholesterol diet, and not smoking.

 

Conclusion

In this high-risk and inoperable group, transcatheter aortic valve implantation (TAVI) was established as an alternative to the surgical technique. TAVI is a catheter-based, minimally invasive treatment used to restore the aortic valve's functionality. The incidence of aortic stenosis and comorbidities may increase the risks involved with surgical aortic valve replacement, making TAVI an ideal alternative for some patients. TAVI is indicated for individuals at intermediate or greater risk for open heart surgery (SAVR). The complete process usually takes between one and two hours. The optimal technique will be decided by a heart team made up of cardiac surgeons, interventional cardiologists, and other specialists in aortic stenosis. This team will also take other factors into accounts, such as whether the patient should be given a moderate sedative or general anesthesia.