Why Do I Need A Tavi
The aortic valve is one of four main valves in your heart. As your heart beats, the valve opens and closes, allowing blood to flow from your heart to the rest of your body in one direction.As you age, calcium can build up on the aortic valve causing narrowing and degeneration. This can result in the valve not being able to function properly which means the heart has to work harder to pump blood through the narrowed valve. This condition is call aortic stenosis. Aortic stenosis is the most common primary cardiac valve disease leading to surgery or catheter intervention in western countries.
Patients with severe, symptomatic aortic stenosis have a poor prognosis without intervention this mainly includes surgical aortic valve replacement or TAVI.
Transcatheter Aortic Valve Implantation
Transcatheter aortic valve implantation involves inserting a catheter into a blood vessel in your upper leg or chest and passing it towards your aortic valve.
The catheter is then used to guide and fix a replacement valve over the top of the old one.
The main advantages of this technique are that the heart doesn’t need to be stopped, so a heart-lung machine doesn’t need to be used, and it avoids making a large cut in your chest.
This puts less strain on the body and may mean TAVI is more suitable for people who are too frail to have a conventional valve replacement.
Research suggests the procedure may be as effective as surgery for people in whom surgery would be difficult or risky, and it may result in a faster recovery.
But there’s little evidence to suggest it’s appropriate for people who are suitable for surgery and at a low risk of complications.
Possible complications of TAVI are similar to those of a conventional valve replacement, although the risk of having a stroke after TAVI is higher.
What Is Tavi Heart Valve Replacement
Transcatheter aortic valve replacement a new approach to aortic valve replacement. The operation is carried out in a minimally invasive way. The artificial valve is implanted through a catheter inserted in the femoral artery or a small incision in the chest.
Transcatheter aortic valves are specially designed for this procedure. They are made from the heart tissue of a cow or a pig. The natural tissue is reconstructed and attached to a flexible expanding mesh frame. To implant the valve into the heart, it is pressed around or inside the catheter. The implant is then inserted and guided to the aortic valve opening in the heart.
Using modern visualization, the valve is checked for proper placement. It is implanted on top of the existing valve. The valve expands and is fixed inside the aorta. It starts to function immediately and restores blood flow.
After the operation, the patient is transferred to the intensive care unit for several hours. The rehabilitation period of the patient lasts no longer than 3 days.
Since only biological valves are installed during the TAVI intervention, antithrombotic drug therapy lasts for 3 months. Full recovery of the patient comes in 2-3 weeks. After the open surgery, this period is extended by several months.
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Why Doesn’t Everyone Get A Minimally Invasive Procedure
Your goal and the goal of your health care team is to get the best and safest treatment possible for you. That means tailoring the treatment to your heart, your valve disease, your age, your general health and other factors unique to you. Because were all different, not everyone with the same kind of valve disease needs the same kind of repair, the same kind or size of replacement valve, or the same approach.
What Is The Tavi Minimally
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Question: I have been diagnosed with severe aortic stenosis in a heart valve. I am now having more symptoms, such as chest pains and shortness of breath. Ive heard about a minimally-invasive procedure called TAVI. How does it compare to heart surgery to replace the valve.
Answer: The TAVI procedure is currently being performed on only those patients who are not suitable for open-heart surgery. Of course, you could be one of those people. So its worthwhile exploring this option.
Lets start with an explanation of the aortic valve, which is the source of your medical problem.
The aortic valve regulates the flow of oxygen-rich blood from the heart into the main blood vessel leading to the rest of the body. It is composed of three triangular-shaped flaps that fit neatly together.
As the main chamber of the heart contracts, the flaps open up and allow blood to enter into the artery. They then slap shut to prevent blood from flowing back into the heart. As with other parts of the body, over a long period of time this valve can wear out and become dysfunctional.
Aortic-stenosis is, for the most part, a chronic degenerative process of aging. says Dr. Sam Radhakrishnan, Director of the Cardiac Cath Labs and Physician Lead of the TAVI program at Sunnybrook Health Sciences Centre.
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What Is Transcatheter Aortic Valve Replacement
Transcatheter aortic valve replacement , also known as TAVR or transcatheter aortic valve implantation , is a procedure to treat aortic stenosis, a narrowing of the aortic valve. The narrowing blocks the flow of blood to your body and forces your heart to work harder. This causes symptoms such as chest pain and shortness of breath.
TAVR replaces an aortic valve that is not working properly or is diseased with an aortic valve made from animal tissue. The TAVR procedure is minimally invasive, requiring only a small cut in the skin. It does not require open-heart surgery.
The aortic valve is one of four valves that control blood flow in the heart. The aortic valve specifically controls the blood that runs from the heart through your aorta and to the rest of the body. Over time or because of a congenital heart defect, you can develop aortic stenosis, a type of heart valve disease. Your healthcare provider may explain risks and benefits of both TAVR and open-heart surgery. This information will help you decide which one is better for your specific needs.
Aortic Valve Balloon Valvuloplasty
Aortic valve balloon valvuloplasty involves passing a thin plastic tube called a catheter through a large blood vessel, into the heart.
A balloon is then inflated to open up the aortic valve.
This can help treat a narrowed aortic valve , but doesn’t help with a leaky aortic valve .
Guidance from the National Institute for Health and Care Excellence on aortic valve balloon valvuloplasty recommends that it should only be used in people who are not suitable for conventional open surgery.
It can also be used as a short-term treatment for babies and children until they’re old enough for valve replacement.
The main drawback with this type of treatment is that the effects may only last for up to a year. After this, further treatment is needed.
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The Heart Valves Functions
The valves make sure blood keeps moving in the right direction. Between heartbeats the aortic, pulmonic, mitral and tricuspid valves close to prevent blood from flowing backward. If a valve isnt working right, your heart needs to work harder to keep the blood moving in the right direction.
The interventional cardiologists at Norton Heart & Vascular Institute use two kinds of aortic replacement valves for TAVR: the Edwards Sapien valve and the Medtronic CoreValve. The Edwards Sapien valve is made from cow heart tissue and is supported by a cobalt and chromium frame. The Medtronic CoreValve is made from pig heart tissue and has a frame made from a flexible nickel-titanium alloy.
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The Transcatheter Aortic Valve Implantation Procedure & Risks
The TAVI procedure, whilst complex, is a much simpler process to perform thanks to its less invasive technique. The steps are usually as follows:
Once the TAVI procedure has been fully performed, patients can expect some mild discomfort at the catheter entry site but much less than would be experienced after open-heart surgery. Pain relief will be administered to help with this, and in most cases, patients can return to their homes within a few days. Patients will experience different recovery times depending on how the TAVI procedure has gone but expect a quicker recovery than open-heart surgery.
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How Do I Prepare For Tavr
Before surgery, your medical and surgical team will evaluate your overall health. This may include X-rays, CT scans, blood tests and other tests to check the health of your lungs and heart. Your medical team will also give you an echocardiogram to evaluate your aortic valve. This test uses sound waves to create images of your heart. Your medical team may also do a cardiac catheterization to evaluate the arteries that supply blood to your heart. You will also need to:
- Tell your healthcare provider about any drugs you are taking, including over-the-counter medicines.
- Quit smoking if you still smoke, because continuing to smoke increases the risk of a procedure-related problem with your lungs.
- Stop certain medicines if your health care provider instructs you to.
- Stop eating and drinking, usually at midnight before surgery.
What Happens Before This Procedure
Before you undergo TAVR, youll likely undergo the following diagnostic tests, which will help your provider plan out the best way to do the procedure:
Blood tests
These tests will look for any problems with blood clotting, kidney function and more.
Echocardiogram
This test uses ultra-high-frequency sound waves to create a picture of your heart . There are two possible ways this test can happen:
- Transthoracic: This method involves a device held against your skin that can see into your chest .
- Transesophageal: Transesophageal echocardiogram lowers an ultrasound device into your throat. Your esophagus, the tube between your mouth and stomach, runs right behind your heart, making it an ideal way to get an even closer view with sound wave-based imaging. However, most people will not need this as part of their analysis.
Electrocardiogram
Electrocardiogram involves several different sensors stuck to the skin of your chest. Those sensors pick up your hearts electrical activity and show it as a wave on a printout or a computer monitor. The wave’s shape helps providers make sure your heart’s electrical system is functioning as it should be.
Other imaging tests
The most likely imaging test is a computed tomography scan, which takes a series of X-ray images that a computer then assembles into a three-dimensional image.
Left heart catheterization
After testing
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What Happens After This Procedure
After the TAVR procedure is over, medical staff will stop either the general anesthesia or the moderate sedation, allowing you to wake up. However, theyll keep you in bed for several hours . Thats because the entry point for the catheter was a major blood vessel, and they want to make sure the stitches are secure because that blood vessel can bleed heavily if the stitches arent before letting you get up. Your healthcare provider will also likely refer you to a cardiac rehabilitation program, which youll start within several days of your TAVR procedure. Cardiac rehab programs are like a prescribed workout plan that involves a team of medical professionals from several different fields. These professionals include exercise physiologists, nutritionists, nurses, doctors and more. Their goal is to help you increase your hearts strength and endurance, which will help your recovery and your long-term outlook.
Why Would I Need To Undergo Tavr
Your heart has four valves, and blood flows through each one in sequence. The last of the four is the aortic valve. Your heart pumps blood through that valve and out to the rest of your body. TAVR is a procedure that replaces that valve without major surgery.
The most common reason to undergo TAVR is if you have aortic stenosis, which is narrowing the aortic valve or the area around it. That narrowing is usually due to calcium buildup on the valve and age-related wear and tear . It can also happen because of other health conditions.
Narrowing of the valve limits how much blood flows out to the rest of your body, forcing your heart to pump harder to compensate. That usually leads to long-term damage to your heart muscle and then heart failure.
Many people who need aortic valve replacement are high-risk, either because of the severity of the stenosis or other health conditions. That means they have a greater risk of complications or death from such a major surgery, and TAVR is their only option. In 2019, the FDA also approved TAVR for people who are at low risk for complications from surgery. TAVR also has FDA approval for people who previously had valve replacement surgery.
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What Are The Advantages Of This Procedure
TAVR has several advantages compared to surgery, which is why it’s now the most common method for replacing the aortic valve. Some of those advantages are listed below.
TAVR is less invasive than surgery
Most surgeries on your heart involve larger incisions in your chest. Surgeons also often have to lift or even crack and spread open your rib cage to do heart surgery. Minimally invasive surgery techniques reduce how much surgeons do this but can’t eliminate it. TAVR involves one small incision only, with no need to move any of your internal organs or ribs.
Easier recovery
Limiting the number and size of the incisions also means theres less for your body to heal. That means theres less pain and an easier recovery.
Shorter hospital stays
Heart surgeries usually involve a hospital stay that lasts several days. Depending on where you undergo TAVR, some hospitals send most people home the same day or the next day. That also depends on what time they had their procedure, the severity of their case and their overall health.
Better outcomes
Early on, clinical studies and trials found that TAVR was more likely to be successful and less likely to cause death or major complications among people with higher risks for complications from surgery. Later trials on low-risk individuals had similar results, finding that people who underwent TAVR had:
- Higher one-year survival rates.
- Lower rates of rehospitalization within a year.
What Is Transcatheter Aortic Valve Implantation
Transcatheter aortic valve implantation is an option for the treatment of aortic stenosis for patients who are not suited for traditional open heart surgery.
Aortic stenosis is the progressive thickening and hardening of the heart valve flaps which restrict their opening when the heart contracts. This can cause a thickening of the heart muscle and a decrease in the flow of blood to the body and coronary arteries .
The most common intervention for heart valve replacement is open-heart surgery. However, a less invasive way of performing the surgery has been developed where the valve replacement is done without open heart surgery, known as transcatheter aortic valve implantation .
The majority of TAVI valves can be inserted via the femoral artery .
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Tavr Once Was Available Only For The Sickest Aortic Stenosis Patients But The Minimally Invasive Procedure Is Now More Often An Alternative To Open Heart Surgery
Story by: Norton Healthcare on November 29, 2019
The minimally invasive transcatheter aortic valve replacement procedure once thought appropriate only for the sickest aortic stenosis patients increasingly is being used as an alternative to open heart surgery valve replacement.
TAVR is an option now for nearly all patients.
With TAVR, were able to place the new valve by entering through an artery, much like we would a stent, said D. Sean Stewart, M.D., interventional cardiologist with Norton Heart & Vascular Institute. Patients eligible for this minimally invasive approach often go home after an overnight stay.
TAVR is now an option even for patients for whom open heart surgery for valve replacement would be low risk. The procedure was at first only for those who faced high risk if they underwent open heart surgery, then expanded to include those with intermediate risk.
Open heart surgery is still preferred for younger patients, those with congenitally malformed valves and other specific cases.
Aortic stenosis means the valves have narrowed, become calcified and rigid. One in 2 patients with untreated symptoms of severe aortic stenosis will die within an average of two years.
What Does The Tavi Procedure Involve
A transcatheter aortic valve implantation procedure is usually performed under local anaesthetic but may involve a general anaesthetic in some cases.
A plastic tube called a sheath is inserted into a large arterial blood vessel in the groin. This allows catheters to pass through the femoral artery into your heart.
A temporary pacing wire is inserted into a vein in the neck or leg and guided to the right ventricle . It is then connected to a temporary pacemaker, a small battery operated box, which can control the heart rate during the deployment of the valve. The temporary pacing wire is typically removed during the procedure but in rare cases it might be left in for a few days.
A transoesophageal echocardiogram probe may be passed through your mouth and positioned in your oesophagus. This imaging helps guide and monitor your progress during the procedure. This is done while you are under general anaesthetic.
A thin tube with a balloon attached is then placed within the narrowed aortic valve. The balloon is inflated to open the narrowed leaflets of the valve, and the balloon removed. X-rays are used to see the exact position of the catheters and the valve.
The valve consists of a bovine heart valve that is fixed on a metal frame. This valve is mounted onto another balloon catheter and passed through the sheath in your groin and placed in your now freely moving but still diseased aortic valve.
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