TAVI at the Heart of Innovation: How Valve Technology Has Changed Cardiac Care

Let's say you are a 75-year-old woman who regularly walks your dog every day. Over the past few months, you've noticed that you are becoming increasingly short of breath. Although you consider yourself to be in optimal health for your age, you are not too concerned at first. You think it might be a good idea to pick up the pace or change your exercise routine to improve your endurance. However, your situation worsens as you start to feel increasingly fatigued, and one day you even feel like you might pass out.

Concerned about your health, you visit your doctor, who after ordering some diagnostic tests, later informs you that you have a condition called aortic stenosis and may require a TAVI (transcatheter aortic valve implantation). Having never heard of these terms before, you start to seek more information.

Aortic stenosis is a common and serious valve condition, especially among individuals over the age of 75. In the past, the gold standard treatment for aortic stenosis was open heart valve surgery. However, this changed when advancements in valve technology began to transform cardiac care.

TAVI Work-Up and Tests

Prior to the day of the procedure, you will undergo a series of tests that will help your surgical team determine the safest approach for your new valve. The following tests will be performed:

1.Echocardiogram - This test acts like an ultrasound but is specifically designed for your heart.

2. CTA (Computed Tomography Angiography)- A CT scan that focuses on your aorta.

3. Coronary Angiogram - In this test, a special dye is used to highlight the blood vessels in your heart, allowing the team to check for any blockages caused by atherosclerosis. You can think of these tests as a roadmap for your surgical team.

The purpose of these tests is to gather necessary information before your procedure. You will receive details about what to expect on the day of your TAVI, what your recovery will be like, and when you can go home. Keep in mind that everyone's journey is different; while your experience may vary, your healthcare team will provide guidance on what to expect. Having more information can help reduce anxiety as you prepare for the procedure.

In a previous article, we talked about aortic stenosis, which involves the heart valves acting as gateways that allow blood to flow in one direction and prevent it from flowing backward. The aortic valve is responsible for directing blood from the left side of your heart into your body via the aorta. When this valve becomes calcified and thickened, blood flow is obstructed. A narrowed valve opening leads to a condition known as aortic stenosis. Some of the symptoms include difficulty breathing, swollen feet, fatigue, chest pain, and fainting. While symptoms can be managed in the early stages, they can worsen and start to affect your daily activities, blood pressure, and contribute to congestive heart failure, impacting your left ventricular function. When aortic stenosis becomes severe, a new valve is necessary.

TAVI involves placing an artificial valve to replace your damaged or calcified valve. The valves come in different materials: tissue valves made from animal tissue or mechanical valves made of metal. The TAVI procedure is less invasive because it does not require opening your chest. Instead, the new valve is inserted through an artery, usually accessed via your groin. Once the new valve is in position, it expands, pushing the old valve aside, and begins functioning immediately. TAVI procedures were previously done under general anesthesia; now they are conducted with conscious sedation.

What to expect on the day of the procedure

After completing some safety checks, an intravenous line will be inserted. The cardiologist will then start the procedure. The puncture site will be in your groin, which is the access point to your femoral artery. You will receive a local anesthetic to ensure that you do not feel any pain. A small incision will be made in your groin to provide the cardiologist access to your artery.

The cardiologist will then feed a tube, called a catheter, into your artery and guide it up to your heart. At this point, the replacement valve will be passed through the catheter into your existing valve. Once it is in the correct position, the new valve will be expanded, pushing your old aortic valve to the side. The catheter will then be removed, and pressure will be applied to the puncture site.

After the procedure, you will be sent to a cardiac intensive care unit (ICU) or a short stay unit, where you will be closely monitored for any complications. The usual length of stay is between 1 to 3 days.

It's important to understand that TAVI is an invasive procedure and carries potential risks of complications. Your doctor will discuss these risks with you, ensuring shared decision-making and considering the possibility of improved quality of life.

Reference

Naser, N. (2023). Transcatheter aortic valve implantation: Two decades of evolution—TAVI from current perspective. Medical Archives, 77(1), 64–68. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10875938/ 

 Book (NCBI Bookshelf):

Puri, R., & Mack, M. J. (2016). Transcatheter aortic valve replacement (NBK431075). In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK431075/

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