Dr Ankur Phatarpekar TAVI | TAVI proctor | TAVI Specialist Mumbai

TAVI

Q. What is Transcatheter aortic valve implantation (TAVI)?

Transcatheter aortic valve implantation (TAVI) is a minimally-invasive procedure in which an artificial aortic valve is attached to a small hollow tube (catheter) and then inserted in the patient’s blood vessels, which is guided to travel to the heart through certain imaging technologies.

The valve attached to the catheter is inserted in the blood vessels of the groin or chest by making a small incision in the patient’s leg or chest.

The transcatheter aortic valves are derived from natural tissues, either by using human heart tissue from a donor or the heart of an animal, like a cow or pig.

Q Why is TAVI (transcatheter aortic valve implantation) procedure done?

The transcatheter aortic valve implantation procedure is done when the patient’s aortic valve is not working properly and they are at high risk for open heart surgery. The dysfunction of the aortic valve may be fatal as it leads to certain heart valve diseases, like aortic regurgitation (backflow of blood) or aortic stenosis (narrowing of the valve).

If the heart valve disease worsens, it can diminish the proper supply of blood, causing progressive heart failure, and requiring the replacement of the diseased aortic valve with a healthy functional valve.

The following patients are at high-risk for open heart surgeries and may require transcatheter aortic valve implantation which is a minimally-invasive procedure and does not require fully opening the heart or chest:

Elderly patients or patients with advanced age.
Patients having a weak heart.
Patients who have undergone previous heart surgeries.
Patients suffering from other chronic diseases, like diabetes, kidney disease, chronic obstructive lung disease (COPD), or a history of stroke.
Patients with calcium deposits in the blood vessels of their heart.

Q. Why does a patient need transcatheter aortic valve implantation?

Our aortic valve acts as a gateway. It opens to let blood pass and closes as soon as the blood has passed through the valve to prevent backflow of blood. However, in certain conditions, like aortic valve diseases, the flaps (leaflets) of the valve get damaged, preventing the valve from closing as the blood passes. If the valve does not close, the blood can move backward instead of going forward.

And due to valve dysfunction, the proper blood supply to the heart and the rest of the body gets deprived, and the patient may need implantation of a healthy valve to restore proper blood circulation.

A patient may require transcatheter aortic valve implantation (TAVI) when opening the entire heart for surgery to replace the damaged valve carries certain risks, and can worsen their disease. Hence, an implantation procedure, like TAVI that replaces the diseased valve with a healthy valve without heart surgery is done.

Q How should a patient prepare for a TAVI procedure?

Before the TAVI procedure, the doctor may prepare the patient for the implantation by performing specific tests to examine the overall health condition of the patient. Some important tests before the implantation procedure may include an electrocardiogram (ECG), CT scan, blood tests, X-rays, and echocardiograms. These tests are helpful to create an image of the body and organ functioning of the patient, such as an echocardiogram may evaluate the image and functioning of the aortic valve.

The doctor may also ask the patient to quit smoking or drinking alcohol after the implantation has been scheduled and avoid eating and drinking after midnight before the surgery. If the patient is taking certain OTC, herbal products, supplements, or other medications, the doctor may ask them to quit certain drugs before surgery.

Q How is the TAVI procedure done?

The steps of the TAVI procedure can vary depending on the patient’s condition and how the doctor plans to follow the procedure. Here is how transcatheter valve implantation is commonly done:

You will be admitted to the hospital one or two nights before the surgery or on the morning of your surgery day.
Your doctor will monitor your vitals, like blood pressure, breathing, and blood oxygen level, and may perform some tests, or administer certain medications before the surgery.
You will be given general anesthesia before the beginning of the surgery.
To support proper breathing during surgery, a breathing tube may be inserted in your trachea or a ventilator may be attached.
Next, your doctor will make a small incision in your groin or chest.
The doctor may attach some additional catheters to your heart for monitoring and imaging the implantation procedure.
A valve attached to a small tube (catheter) will be inserted in the blood vessels of your groin or chest.
The replacement valve will be guided to the heart.
Once the valve reaches the heart and replaces the old valve, the doctor will monitor its functioning, and then remove the catheter and close the incision with sutures or stitches.

Q What happens after transcatheter aortic valve implantation?

After the implantation procedure, the patient will be transferred to the intensive care unit (ICU) for additional care and close monitoring of the overall health condition and heart functioning.

The patient is commonly discharged from the hospital within 1-2 days or more depending on the speed of recovery. Complete recovery may take a few weeks and require additional and extensive care throughout the healing process, such as:

Close monitoring for any signs of bleeding, discharge, redness, or swelling at the insertion sites.
Regularly taking any medications prescribed by the doctor on time.
Avoid weight lifting, driving, or any sexual or rigorous physical activity.
Avoid smoking.
Maintaining a healthy and balanced diet.
Maintaining follow-up appointments

What are the risks of the TAVI procedure?

With trained, experienced, and expert cardiologists, there are minimal chances of complications or risks with the TAVI procedure. However, some common risks may include: