Transcatheter Aortic Valve Implantation (TAVI), sometimes also referred to as Transcatheter Aortic Valve Replacement (TAVR), is a relatively new, minimally invasive interventional procedure to treat aortic stenosis or narrowing of aortic valve opening. This is a pioneering procedure that is an alternative to the conventional approach of surgical valve replacement.
Underlying condition and symptoms
The aortic valve is one of the four valves of the human heart. It separates the lower left chamber of the heart (left ventricle) and the aorta – which is the main artery of the body. The valve regulates the flow of blood into the aorta by opening and closing. When the valve thickens and narrows, the opening is restricted and affects the flow of blood causing symptoms like breathlessness, fatigue, chest pain, palpitation and dizziness. In this situation, the valve is rendered un-viable and a prosthetic valve needs to be implanted.
TAVI as a choice of treatment
Surgical valve replacement (AVR) has been the conventional treatment of choice. However, many patients are deemed intermediate / high risk for surgical valve replacement e.g. those who have undergone prior cardiac surgery, those of old age (senile degenerative aortic stenosis) and/or comorbidities like kidney failure and severe asthma. These patients become suitable candidates for TAVI. TAVI is performed by a trained interventional cardiologist who is licensed to implant the valve independently.
The decision to perform TAVI to treat aortic stenosis is made after a multidisciplinary group of medical as well as surgical heart specialists are consulted who will together decide the best treatment option for an individual.
How it’s done and what to expect
Firstly, as part of diagnosis a series of tests may be done to establish the condition – including Coronary Angiogram, CT Angiogram, ECG, Chest X-Ray, TMT to name a few. The size of the implant required and the diameter of the artery for insertion of the catheter is assessed.
The valve is mounted on a catheter inserted usually through the groin and guided till the site of the aortic valve and inflated inside the existing valve using a balloon. It starts functioning immediately. The procedure is done under anaesthesia, conscious sedation or local anesthesia depending upon the medical requirement. Blood loss is minimal and there is absolutely no kind of surgical intervention involving any type of cutting / bypass etc. The new valve has biological tissue leaflets and does not require anticoagulation (or blood thinners).
Post-procedure, you will be monitored in the ICU to ensure you are stable. Typically, discharge is done in 3-5 days. You will be prescribed some medication including anti-coagulants and anti-biotics as well as lifestyle modifications and asked to return for regular check-ups.