Transcatheter Aortic Valve Implantation (TAVI), also referred to as percutaneous aortic valve replacement, is a minimally invasive procedure to treat severe symptomatic aortic stenosis. Aortic stenosis is a condition where the heart’s aortic valve becomes narrowed or obstructed, preventing it from opening properly and blocking the flow of blood from the left lower chamber of the heart to the aorta. In the early stages, patients with severe aortic stenosis may have no symptoms. However, as the disease progresses, classical symptomatic of breathlessness on exertion, chest pain and syncope heralds a more sinister prognosis.In a TAVI procedure, the diseased aortic valve is replaced to restore normal blood flow.
Transcatheter aortic valve implantation (TAVI) is performed through a small incision of four to six cm at the groin or chest where a balloon catheter pre-mounted with a tissue valve is guided to the diseased heart valve. The doctor uses echocardiographic and fluoroscopic guidance for visualisation during the valve delivery. Once at the diseased site, the new valve is placed across the stenotic valve by balloon expansion. This method reduces the trauma to patients as the heart need not be opened up as with the case of the surgical approach and could possibly lead to a faster recovery and shorter hospital stay.
Patients with severe aortic stenosis and are not suitable for surgical aortic valve replacement due to multiple medical problems, such as very advanced age, poor heart function, renal failure, severely calcified aorta, previous scarred chest due to surgery or irradiation.
If transcatheter aortic valve implantation (TAVI) is considered as therapy for high risk surgical patients for treatment of aortic stenosis, a computed tomography (CT) scan will be done prior to TAVI to assess suitability and help plan the approach and type of TAVI valve to be used. Coronary angiogram will be performed prior to TAVI and significant coronary stenosis treated first to improve safety prior to TAVI. Dental clearance will also need to be done prior to TAVI to reduce the risk of infective endocarditis.
Patient after a successful TAVI procedure will be monitored in hospital for complications, assessed for the correct function of the newly implanted TAVI and ambulated back to their baseline ambulation status prior to discharge which usually is within a week of the TAVI procedure. After TAVI, aspirin and clopidogrel will be prescribed for three to six months. Patients can generally resume normal activities after one week. Good dental hygiene needs to be maintained and patients will require antibiotic prophylaxis for invasive dental treatment after TAVI.
Transcatheter aortic valve implantation (TAVI) – An alternative treatment for symptomatic severe aortic stenosis patients with high surgical risks (Medical News)
