Transcatheter Aortic Valve Implantation (TAVI)

Valvular stenosis is a potentially fatal heart condition that becomes a greater risk as people age. While replacing a damaged valve has been possible for some time, the major open-heart surgery associated with it comes with some level of risk, especially considering that patients who require this surgery are often elderly. Now, however, the latest medical advancements mean that a damaged valve can be replaced without the need for major open heart surgery, significantly reducing the associated risks and speeding up the recovery time.

Valvular stenosis occurs when a valve opening becomes smaller than normal. It is a condition that most commonly affects the aortic valve, which opens and closes to regulate blood flow throughout the body. When the heart’s aortic valve narrows, it prevents the valve from opening fully. This obstructs blood flow from the heart into the aorta, leading to heart failure and ultimately proving fatal. Aortic valvular stenosis is common in older men and women because, as people age, their heart valves may accumulate deposits of calcium, leading to restricted blood flow.

As it usually shows no visible symptoms, aortic valvular stenosis is a silent condition that is only diagnosed when a comprehensive physical examination has been performed. However, some of the warning signs include fatigue (even while performing routine daily activities), feeling faint, chest pain or tightness of the chest, and an inability to sleep lying flat in bed. If you or a loved one experiences any of these abnormalities, please see a doctor for diagnosis.

To diagnose the condition, the doctor will first review the patient’s medical history and symptoms, before conducting a physical examination. The doctor may also choose to conduct various tests, including an EKG and echocardiogram, so as to evaluate the severity of the condition. There are three categories of severity: mild, moderate, or severe. In mild and moderate cases, valve replacement may not be necessary. However, when the narrowing becomes severe, the doctor will recommend surgery.

Aortic valve replacement is performed by removing the narrowed aortic valve and replacing it with a prosthetic heart valve. While this has long been considered the most effective primary treatment, the traditional technique involves major open-heart surgery that requires anesthesia and the use of a heart-lung machine. The procedure takes about 3-4 hours to complete. It is not appropriate for some patients, such as those who are very old, those who have previously undergone chest surgery, and those with certain medical conditions.

However, for patients who cannot undergo major open heart surgery or who are at increased risk of complications, a groundbreaking new technique can now be performed. Utilizing the latest medical technology, Transcatheter Aortic Valve Implantation (TAVI) involves replacing the aortic valve with a prosthetic valve via the femoral artery in the leg (like balloon angioplasty). In this procedure, the doctor inserts a catheter through the leg and guides it to the heart and into the aortic valve. The catheter has a folded valve around it. Once it is in place, the doctor then expands the valve to replace the narrowed one.

As TAVI does not involve major open-heart surgery, patients can recover more quickly. The procedure requires only a small incision where the catheter is inserted. As a result, patients will typically only need to stay in hospital for no more than 5-7 days after the procedure depending on the doctor’s approval. While no surgery is without risk, TAVI is an exciting development because it makes it possible for doctors to help patients who may otherwise not have been as lucky in the past. In short, it’s a revolutionary new way to help more people prolong their lives.

Even with this new technique, prevention is, as always, better than cure. Therefore, it is very important to have regular heart checkups so that this and any other condition can be detected early.

By Dr. Wattanaphol Phipathananunth, Cardiologist, Heart Center, Bumrungrad Hospital

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