TAVR / TAVI
TAVR (Transcatheter Aortic Valve Replacement) or sometimes called Transcatheter Aortic Valve Implantation (TAVI) is done when a person has suffered a heart attack or faced symptoms of a heart attack.
TAVI (sometimes called transcatheter aortic valve replacement or TAVR), is a less-invasive procedure than open-heart surgery. TAVR procedure uses a catheter to implant a new valve within your diseased aortic valve. TAVI can be performed through multiple approaches. However, the most common approach of TAVI 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.
If the patient has mild to severe aortic stenosis, the goal is to regulate and lower cholesterol, maintain healthy blood pressure, exercise, and follow a strict diet while taking medication. If the condition is severe, the valve will harden even more and blood flow becomes very low, the patient may experience symptoms such as chest tightness,shortness of breath, and fainting. It can potentially cause heart failure and death from a heart attack. The doctor may recommend Transcatheter Aortic Valve Replacements(TAVR or TAVI) or Open Heart Surgery to alleviate the symptoms and signs of Aortic Stenosis.
Benefits of TAVR/TAVI
Low Complication Rate:
TAVI Procedure has minimal risks of all causes and cardiovascular mortality,stroke, life-threatening bleeding, and major bleeding complications.
Fast Recovery Vs Surgery:
TAVR or TAVI provides for a faster post-procedure discharge, including direct discharge to the patient's home.
Better Quality of Life:
Alleviations of symptoms:
The majority of TAVR or TAVI patients will become asymptomatic and more active in the years post-procedure.
Extended Life Expectancy:
Patients who have undergone TAVR or TAVI have a greater rate of survival, even when they are classified as inoperable.
Observed Durability:
The partner trials have exhibited five years of outcomes, demonstrating continued durability and excellent hemodynamic performance.
Difference Between TAVR/TAVI and Open Heart Surgery
| TAVR or TAVI |
Open heart surgery |
| The average TAVR procedure may take up to 1-2 hours, depending on the complexity. |
The average time for open heart surgery is up to 4 hours. |
| Less anxiety and mental uneasiness. |
Might take a mental toll throughout the recovery process.(Only a few patients go through this) |
| No bone is cut in TAVR or TAVI. |
Ribs are cut near the chest to proceed with the operation. |
| Skin infection is near zero as no bone is cut. |
Chances of having infection complications after cardiac surgery occurs in 5% to 21% of cases. |
| TAVR cut is mere 4 cms. |
A 6-8 inch incision is made to process the surgery. |
| The recovery time of TAVR is less than 2-3 days to 1 week. |
Open heart surgery recovery time varies from 6-12 weeks, depending on the patient’s health. |
Evaluation of TAVI/TAVR
While TAVR or TAVI was originally developed specifically for patients at high risk with open-heart surgery, it's now approved for anyone with severe aortic stenosis.
You may have all or some of the following tests as part of the evaluation of heart problems:
- Blood tests
- A chest x-ray can show the size of your heart and reveal whether you have fluid buildup in your lungs.
- An electrocardiogram(EKG) is a painless test to assess the heart's electrical activity.
- A transesophageal echocardiogram(TEE) is a heart-imaging test in which an ultrasound probe is put into your esophagus in order to obtain clear images of your heart's chambers and valves, and assess how blood flows through your heart.
- A cardiac MRI or cardiac CT scan provides detailed images of your blood vessels, the blood flow through your heart, and your heart's structure and motion.
Who Isn't Eligible for TAVR/TAVI
The TAVR valve should NOT be used for patients who:
- Have an infection
- Have a mechanical valve
- Cannot take blood-thinning medicines
- Have a reaction to some metals
- Have a reaction to some imaging solutions
Who is eligible for TAVR/TAVI Procedure/ Operation?
If the patient had a Heart Attack or faced symptoms of heart attack and
- Is sensitive to open-heart surgery.
- It has a high risk of surgical complications.
- Is conditioned to be suffering from kidney or lung diseases and cannot undergo invasive surgery.
- Have an existing valve that was previously inserted to replace the original aortic valve, but it isn’t functioning well anymore.
The decision to treat aortic stenosis by TAVR procedure is made after following some tests prescribed by your doctor.
Risks of TAVI/TAVR
The most common risks and complications associated with TAVR or TAVI include:
- Damage to the blood vessels.
- Bleeding.
- Decreased blood supply to the brain, causing a stroke.
- Heart attack.
- Kidney failure.
- Collection of fluid around the heart.
- Leaking of the replacement valve.
- Severe heart failure.
Treatment Option
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.
Transcatheter Aortic Valve Implantation
TAVI has emerged as an option for the treatment of inoperable patients with severe Aortic Stenosis (AS) following heart team assessment. Clinical characteristics and anatomy considered as contraindications for surgery include porcelain aorta, deleterious effects of chest-wall irradiation, oxygen-dependent respiratory insufficiency, and frailty. TAVR or TAVI less-invasive, beating heart procedure is commonly performed via transfemoral (TF) access, which requires no general anesthesia and reduces patient time in intensive care.
Two other alternatives, the transapical (TA) or transaortic (TAo) approaches, can be used if TF access is not feasible due to anatomical contraindications.TAVI is also a therapeutic alternative in high and intermediate-risk patients considered suitable for surgery, but where TAVI is preferred based on individual risk profile assessed by a heart team. The PARTNER TRIAL (Placement of Aortic Transcatheter Valve Trial), large randomized studies using the Edwards SAPIEN valves, supported this established treatment option in symptomatic patients with severe Aortic stenosis.
What are the Tests Done Before TAVR or TAVI 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 or TAVI Procedure:
- The Specialty team will make sure you understand the precautions to take before and during the Transcatheter Aortic Valve Replacement (TAVR) or TAVI procedure.
- Before beginning the TAVR or TAVI procedure, you may ask questions you have. Don't be hesitant to ask all your questions before the procedure.
- Depending upon your condition and age, anesthesia will be given. You may be asked to join the hospital the day before the TAVR or TAVI procedure to follow up with the formalities.
- To start the procedure, your doctor will prescribe anesthesia by monitoring the heart rhythm and pulse. Then they inject a medication to prevent blood clots during the TAVI procedure.
- A minor 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 forms.
- The doctor will then remove the tube and close the cut, after which the catheter with the TAVI implant will be placed.
- The aortic valve that was replaced by a new valve should work well. Your doctor will ensure that your new valve is working fine before he closes the cut.
After The TAVI or 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 of 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 revisit the doctor after taking the TAVR or TAVI procedure.
- To monitor the condition after TAVI or TAVR, you should have a TAVR check every 30 days to 1 year (as per the doctor’s suggestion). In case you face any health changes and discomfort, make sure you visit the doctor.
The Survival Rate of TAVI
The average survival rate of the TAVI procedure is a maximum of 16 years (from the past studies) 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 long recovery time.
Aortic Stenosis in COVID situation
What is Aortic Stenosis?
Aortic Stenosis is a build-up of calcium deposits on the valve, which causes the valve 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 symptoms:
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 times it becomes too late for patients 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.
