What is TAVI or TAVR?
TAVR medical abbreviated Transcatheter Aortic Valve Replacement or sometimes called Transcatheter Aortic Valve Implantation (TAVI) is done when a person had suffered a heart attack or faced symptoms of a Heart Attack.
Basically, a heart attack occurs when the aortic valve of the heart tightens and can’t pump blood to all major parts of the body. The heart pumps blood through the aortic valve to all parts of the body.
When the aortic valve cannot open and close properly due to increase in the thickness of the valve, it becomes narrow and tight and results in difficulty of blood pumping. This is where Aortic Stenosis occurs.
If Aortic Stenosis is from mild to moderate, the patient is aimed to prevent the progression of the disease so, the aim is to control and lower cholesterol, low blood pressure, exercise, diet with strict medication. If it is severe,that means the valve is thickened more and the blood pumping is very low, the patient could develop some symptoms like chest discomfort, shortness of breath, fainting or feeling faint one should immediately see a doctor. It may also lead to heart failure and sudden cardiac death.
To relieve the symptoms and signs of Aortic Stenosis, the doctor suggests Transcatheter Aortic Valve Replacements or Open Heart Surgery.
Difference Between TAVR and Open Heart Surgery
| TAVR | Open Heart Surgery |
|---|---|
| The average TAVR procedure may take upto 1-2 hours and might take upto 8 hours depending on the complexity. | The average time for Open Heart Surgery is upto 4 hours. |
| Recovery Time of TAVR is Less than 2-3 days to 1 week. | Recovery time of open heart surgery is 6 weeks and above, depending on patient condition. |
| TAVR cut is mere 4cms. | 6-to-8-inch incision is made to process the surgery. |
| Skin infection is near zero as no bone is cut. | Chances of having infection complication after cardiac surgery occur in 5% to 21% of cases. |
| Less anxiety and mental uneasiness. | Might take a mental toll throughout the recovery process. (Only few patients go through this) |
| No bone is cut. | Ribs are cut near chest to proceed with the operation. |
Is TAVR Better Than Open Heart Surgery?
TAVI or TAVR Procedure is FDA approved and by far the less invasive Heart Valve Replacement Procedure. While compared to other heart surgeries, this will help you to get back to normal lifestyle faster with very less recovery time.
Benefits of TAVR Procedure
There are many potential benefits of taking TAVI procedure:
- Experiencing very very less pain.
- Less anxiety and mental uneasiness.
- Less procedure involved.
- Only a small cut is made.
- Shorter ICU and hospital stays (2-3 days to 1 week).
- No bone is cut in the process.
- Less anesthesia.
- Nearly zero blood loss.
- Shorter recovery time. (requires less than a month)
- Being able to do everyday activities in a week.
Who Cannot Take TAVR?
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 can have TAVR Procedure/ Operation:
If the patient had a Heart Attack or faced symptoms of heart attack and
- Is sensitive to the open heart surgery.
- Is having 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.
What are the Tests Done Before TAVR Procedure:
If you show symptoms or suffered a heart attack, your doctor might ask you to go through certain tests like Echo-Cardiography, CT Coronary Angiogram are considered to clearly evaluate the condition to confirm on Aortic Stenosis.
Before TAVR Procedure:
For Transcatheter Aortic Valve Replacement (TAVR) procedure, the Specialty team anyways will make you understand the precautions to be taken before and after.
You may also ask any question before starting the TAVR process. Doesn’t refrain, clear all the doubts prior the surgery.
Depending upon your condition and age, anesthesia will be decided. You may asked to join the hospital day before TAVR procedure to follow up with the formalities.
TAVR Procedure:
TAVR sometimes involves replacing diseased aortic valve with cow’s or pig’s heart tissue or with an implant. It always depends on the patients choices and the condition to which the doctor decides.
To start the procedure, your doctor will prescribed anesthesia by monitoring the heart rhythm and pulse. Then they inject a medication to prevent blood clot during the TAVR procedure.
A minor cut is made near the ribs or the groin or the neck and a small hollow tube called catheter is positioned at a suitable place where the cut is made.
Following the heart valve slowly the catheter is taken to the heart chamber where the Aortic Stenosis occurred.
There the catheter that has the TAVR implant is placed immediately and the doctor will then remove the tube and close the cut.
The aortic valve that was replaced by new valve should work good. Your doctor will ensure that your new valve is working fine before he closes the cut.
After the TAVR Procedure:
You may not need more rest as compared to other procedures, You may actually spend 1-2 days in the ICU followed by 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 few more days depending upon the condition and they will also advise when to re- visit the doctor after taking TAVR procedure.
To monitor the condition after TAVR, you should have a TAVR check for every 30 days to 1 year (as per the doctor’s suggestion). In case if you face any health changes and discomfort, make sure you visit the doctor.
Survival rate of TAVR:
The average survival rate of TAVI procedure is maximum 16 years (from the past studies) for patients aged 65 or less.
Although Open Heart Surgery is very well known and most practiced surgery in india, the procedure itself takes about 4 hours and a long recovery time
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
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709202/
- https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/transcatheter-aortic-valve-implantation
- https://www.svhhearthealth.com.au/procedures/procedures-treatments/tavi
Dr. A. Sharath Reddy
- MD, DM, FSCAI, FACC, FAHA
- Sr. Consultant Interventional Cardiologist & Executive Director & Director – CATH Lab
- Medical Registration No: 48549
- Mon – Sat: 10 AM – 4 PM*
- HITEC City, Madhapur