TAVR and TAVI

 

1. What is TAVI?

TAVI stands for Transcatheter Aortic Valve Implantation (also known as TAVR - Transcatheter Aortic Valve Replacement). It is a revolutionary, minimally invasive procedure to replace a thickened aortic valve that can't open properly. Instead of opening the chest (like in traditional open-heart surgery), a new valve is compressed and fed through a catheter (usually through the artery in the leg) and expanded inside the diseased valve.

·         Common Names: TAVR, Percutaneous Aortic Valve Replacement, Keyhole Valve Surgery.

 

2. Common Symptoms Requiring TAVI

Patients usually require TAVI when they suffer from Aortic Stenosis, which restricts blood flow from the heart to the rest of the body. Seek a doctor if you experience:

·         Severe Shortness of Breath: Especially during minimal physical activity.

·         Chest Pain (Angina): A feeling of tightness or pressure during exertion.

·         Fainting or Near-Fainting (Syncope): Especially during or right after exercise.

·         Fatigue: Feeling unusually tired during periods of activity.

·         Heart Murmur: A "whooshing" sound heard by a doctor through a stethoscope.

 

3. List of Associated Diseases

TAVI is specifically designed to treat:

·         Aortic Stenosis: Narrowing of the aortic valve opening.

·         Aortic Valve Calcification: Calcium buildup that stiffens the valve.

·         Congestive Heart Failure: Often caused or worsened by a failing valve.

·         Bicuspid Aortic Valve: A congenital condition where the valve has only two leaflets instead of three.

 

4. List of Screening Tests

Before a TAVI procedure, a "Heart Team" performs detailed imaging to ensure the new valve will fit perfectly:

·         CT Scan (TAVI Protocol): To measure the exact size of the aortic root and check the path through the leg arteries.

·         Echocardiogram (2D Echo): To assess the severity of the valve narrowing and heart function.

·         Coronary Angiography: To check for blockages in the heart arteries that may need treatment first.

·         Blood Tests: To check kidney function, blood counts, and clotting factors.

·         Carotid Doppler: To check blood flow to the brain.

 

5. Am I Eligible for this Procedure?

TAVI was originally for high-risk patients, but it is now available for many. You are a candidate if:

·         You have Severe Symptomatic Aortic Stenosis.

·         You are considered intermediate or high risk for traditional open-heart surgery due to age or other health conditions.

·         Your femoral (leg) arteries are large enough for the catheter to pass through.

·         Note: The final decision is made by a multidisciplinary "Heart Team" consisting of cardiologists and surgeons.

 

6. Pre and Post Care

Pre-Procedure Care

·         Medication: You may be asked to start or stop specific blood thinners a few days before.

·         Fasting: No food or drink for 8 hours prior to the procedure.

·         Dental Check: It is often required to ensure no active dental infections are present to avoid heart valve infection (endocarditis).

Post-Procedure Care

·         Early Mobilization: You will usually be encouraged to walk within 12–24 hours.

·         Medications: You will need to take blood-thinning medications (like Aspirin and Clopidogrel) for several months.

·         Incision Care: Monitor the groin site for any redness or swelling.

·         Follow-up Echo: A scan will be done to ensure the new valve is functioning perfectly.

 

7. Days Required for Hospitalization

2 to 4 Days. The procedure takes about 1 to 2 hours. Most patients spend one night in the Intensive Care Unit (ICU) or a high-dependency ward and are often discharged within 48 to 72 hours, which is significantly faster than open-heart surgery.

 

8. Benefits of TAVI

·         No Large Incision: No need to crack the breastbone (sternum), leading to less pain and lower infection risk.

·         Rapid Recovery: Most patients return to normal activities within one to two weeks.

·         Immediate Improvement: Patients often feel better almost immediately as the heart no longer has to struggle to pump blood through a narrow valve.

·         Lower Complication Rates: Reduced risk of heavy bleeding and respiratory issues compared to traditional surgery.