By Medicover Hospitals / 26 May 2021

Home | Procedures | Transcatheter Aortic Valve Replacement

Article Context:

  1. What is Aortic Stenosis?
  2. Signs of heart valve disease
  3. Causes of Heart Valve Disease
  4. What are the Treatment Options for Aortic Stenosis
  5. What are the Tests Done Before TAVR Procedure?
  6. The Survival Rate of TAVR
  7. Benefits of TAVR
  8. FAQ
  • Heart valve disease occurs if one or more of your heart valves don't work well. The heart has four valves: the tricuspid, pulmonary, mitral, and aortic valves.
  • What is Aortic Stenosis?

  • Aortic stenosis is a build-up of calcium deposits on the valve, which causes it to narrow and reduce blood flow to the rest of your body.
  • As we age, our bodies go through many physical changes. You may not be able to climb stairs as easily. Or you may notice discomfort or inability to participate in normal daily activities. Sometimes changes in your physical health are a result of getting older. But sometimes, these changes may be signs and symptoms of an underlying medical condition, such as heart valve disease—a common condition in which the heart valves do not work the way they should.
  • Signs of heart valve disease

  • Heart valve disease can cause the blood flow from your heart to your body to be disrupted. If your body is not getting enough oxygen this can lead to some of these typical symptoms1:
    • Shortness of breath
    • Chest pain
    • Fatigue (low energy)
    • Lightheadedness, feeling dizzy, and/or fainting
    • Difficulty when exercising
    • Swollen ankles and feet
    • Rapid or irregular heartbeat
  • Because these symptoms can be a sign of a serious problem, it is important to talk to your doctor as soon as you experience symptoms, or if your symptoms worsen.
  • Main Causes of Heart Valve Disease:

  • Congenital Defect: The disease can be something you are born with, affecting the anatomy of the heart.
  • Family History: Sometimes heart valve disease is more common in certain families.
  • Infection or Inflammation: This can cause scar tissue to form in the heart and make it difficult for the valves to open and close properly.
  • Age: Our heart valve muscles can weaken or become damaged as we age, which is why older people are commonly diagnosed.
  • What Happens When Someone Has Aortic Stenosis?

  • Over time, the leaflets of your aortic valve become stiff, reducing their ability to fully open and close. When the leaflets don’t fully open, your heart must work harder to push blood through the aortic valve to your body. Eventually, your heart gets weaker, increasing the risk of heart failure (your heart cannot supply enough blood to your body).
    • Patients with severe aortic stenosis may find it hard to carry out normal activities, like walking to collect the post or climbing the stairs.
    • By the time it is found in many patients, the disease has progressed to an advanced stage. This is why doctors call it severe aortic stenosis. The aortic valve has a severe build-up of calcium and it struggles to open and close.
    • When this happens, your risk of heart failure increases significantly. The outlook for severe aortic stenosis is poor if left untreated.
  • Without treatment, survival rates in patients with severe aortic stenosis are as low as 50% at two years.
  • Aortic Stenosis doesn’t wait …

  • Many patients will die waiting for Aortic Valve Replacement
  • Aortic stenosis is a common public health problem affecting millions of people around the world. It is estimated that up to 12.4 % of people over age 75 have aortic stenosis. About 80% of adults with symptomatic aortic stenosis are male.
  • What are the Treatment Options for Aortic Stenosis?

  • Treatment for aortic stenosis depends on how far your disease has progressed. If your stenosis is mild, medication may be prescribed to help regulate your heartbeat and prevent blood clots. However, if the severity of your stenosis progresses, your doctor may recommend replacing your diseased aortic valve. Severe aortic stenosis cannot be treated with medication. The only effective treatment is to replace your aortic valve.
  • What is Transcatheter Aortic Valve Replacement (TAVR)?

  • TAVR (sometimes called transcatheter aortic valve implantation or TAVI), is a less-invasive procedure than open-heart surgery. This procedure uses a catheter to implant a new valve within your diseased aortic valve. TAVR can be performed through multiple approaches, however the most common approach is the transfemoral approach (through a small incision in the leg).
  • The use of less invasive procedures – particularly TAVI via transfemoral approach performed under conscious sedation and/or local anesthesia, may present an opportunity to minimize ICU and hospital stay - ESC Guidance for the Diagnosis and Management of CV Disease during the COVID-19 Pandemic
  • native-aortic-valve

    What are the Tests Done Before TAVR Procedure?

  • If you have symptoms or had a heart attack, your doctor may recommend that you undergo certain tests, such as an echocardiogram or a CT Coronary Angiogram, to accurately assess your condition and confirm Aortic Stenosis.
  • Before TAVR Procedure

  • The Specialty team will make sure you understand the precautions to take before and during the Transcatheter Aortic Valve Replacement (TAVR) procedure.
  • Before beginning the TAVR procedure, you may ask questions you have. Don't be hesitant to ask all your questions before the procedure.
  • You may be asked to join the hospital day before the TAVR procedure to follow up with the formalities.
  • TAVR Procedure

  • The TAVR procedure does not involve anaesthesia or cutting open the chest.
  • To start the procedure, your doctor will inject a medication to prevent blood clots during the TAVR procedure.
  • A minor (2 mm) cut is made near the ribs or the groin or the neck and a small hollow tube called a catheter is positioned at a suitable place where the cut is made.
  • The catheter is moved carefully along the heart valve to the heart chamber, where the aortic stenosis is formed. The new valve is deployed at the place of the old valve.
  • Your doctor will ensure that your new valve is working fine before he closes the cut. The doctor will then remove the catheter and suture the 2 mm cut.
  • After The TAVR Procedure

  • You may not need more rest as compared to other procedures. You may spend 1-2 days in the ICU followed by a hospital stay in the patient room for another 2-3 days.
  • Nearly all patients start walking in 1 day and are allowed to do small activities in 2-3 days after the procedure, under doctor surveillance.
  • Before you leave the hospital, you will be suggested to restrict some physical activities for a few more days depending on the condition, and they will also advise when to re-visit the doctor for follow-up.
  • To monitor the condition after TAVR, you should have TAVR follow-up checks at 1, 3, 6, 9, and, 12 months duration, as per the doctor’s suggestion. In case if you face any health changes and discomfort, make sure you visit the doctor.
  • The Survival Rate of TAVR

  • The average survival rate of the TAVI procedure is a maximum of 16 years (from the research data) for patients aged 65 or less. Although Open Heart Surgery is a very well known and most practiced surgery in India, the procedure itself takes about 4 hours and a longer recovery time.
  • Benefits of TAVR

    aortic-stenosis-covid-situation

    Aortic Stenosis in COVID situation

    benefits-of-tavr

    Frequently Asked Questions:

    Any heart procedures comes with its own risks and complications. Considering the fact that TAVR procedure is most opted heart valve replacement surgery and is quickly becoming the new gold- standard for treating valve disease, researchers found that people in the TAVR group had significantly lower rates of death.

    A multicenter clinical trial has found that TAVR performed better than open-heart surgery in low-risk patients with severe aortic stenosis.

    TAVR is not as painful as any heart surgery, you many have aches and minor pains after the procedure. Which can be taken care of with the medication prescribed by the doctor.

    For few TAVR might only be an option as they cannot undergo any other surgical operations. Few are eligible for both TAVR and Open Heart Surgery and are comparatively choosing TAVR.

    Recently doctors noted that TAVR therapy is vastly developed in the last 10 years in INDIA and the number of valves replacements made are more than surgical approaches.

    Citations:

  • https://www.ottawaheart.ca/test-procedure/tavi-transcatheter-aortic-valve-implantation
  • https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/understanding-your-heart-valve-treatment-options/what-is-tavr
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