TAVI and Aortic Stenosis: What You Should Know

Transcatheter aortic valve implantation (TAVI) — also known as transcatheter aortic valve replacement (TAVR) — is a minimally invasive surgical procedure that may be an option for people with severe aortic valve stenosis who have been ruled out as a possible candidate for traditional surgical aortic valve replacement (SAVR) surgery. Here is what you should know about this increasingly popular treatment procedure, and the condition it treats.

Aging is a key factor for aortic stenosis.

Aortic stenosis (AS) is the third most common type of cardiovascular disease in the Western world, after hypertension and coronary artery disease. About 7% of the adult population has AS, and the disease continues to grow in countries with rapidly aging populations. Younger people can develop AS, but it is much more common among men and women in their 60s, 70s and older.

The disease can take many years to progress to an advanced stage, and those who have AS often don’t have any symptoms until the narrowing of the aortic valve has progressed beyond mild and moderate to a severe level. Key symptoms include shortness of breath, fatigue, fainting, chest pain or tightness, and heart palpitations. Once the narrowing becomes severe, the risk of heart failure rises significantly. At this point, valve replacement through traditional surgical aortic valve replacement (SAVR), a type of open-heart surgery, or by TAVI, are the only viable treatment options.

TAVI is a catheter-based procedure.

While surgical aortic valve replacement is a form of open-heart surgery, TAVI is a catheter-based, minimally invasive heart procedure. After the patient is properly sedated or anesthetized, the doctor begins by inserting a catheter through an incision in the groin area, then guides it through the femoral artery all the way to the heart. [As an alternative, some TAVI procedures may be performed through a chest incision.]

With the catheter in position, the artificial heart valve is inserted into the catheter and guided through until it reaches the site of the current aortic valve. The doctor pushes it through and secures it into its intended position. The existing valve remains in place, but the replacement valve takes over the valve functions. The full TAVI procedure takes about 1 to 2 hours to complete.

Here is what to expect during post-surgery recovery.

Once the surgery has finished, patients typically stay in the hospital for about 5 days. It is not unusual after the TAVI procedure to have some pain at the site of the catheter insertion (usually groin area), which may continue for several days. A full recovery typically takes about 6 to 10 weeks after the procedure; by comparison, traditional open-heart valve replacement surgery would require several more weeks for full recovery. During that time, your doctor will schedule follow-up visits to monitor healing and rule out of the possibility of post-surgery infection or other side effects.

They will prepare a nutrition, exercise and activity plan that is appropriate for your age and physical condition and is designed to build up your physical strength and gradually return you to a normal level of physical activity. These healthy lifestyle habits can make a significant contribution to life quality and long-term health.

TAVI may eventually overtake traditional open-heart valve replacement surgery as the primary treatment for severe aortic stenosis.

The first TAVI procedure was performed in 2002, but the past five years have seen the procedure achieve surgical outcomes comparable to traditional open-heart SAVR. The quality and durability of prosthetic replacement valves have seen significant improvements in recent years, and studies have shown TAVI matching or exceeding SAVR in life quality improvement, survival rates, and long-term health status. It is not difficult to see that TAVI may soon become the clear procedure-of-choice for treating severe aortic stenosis.

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