What is TAVI ?

Transcatheter Aortic Valve Replacement is a process conducted very nominally to replace a firm aortic valve that cannot open. It has to be replaced because if the aortic valve cannot open, it diminishes the blood flow from the heart to the body. This procedure is required to prevent aortic stenosis which causes risky symptoms like chest pain, breathlessness, etc.

Note : Cardium is the best cardiology center led by a leading Cardiologist in Mumbai, Dr. Rahul Gupta, who has helped many patients get treated with TAVI and TAVR in Mumbai and Pan India. If you are searching for a TAVI Doctor, feel free to connect with us.

Who and why would patient need to option for TAVI ?

The aortic valve is one of the four valves in our heart. The valves open and closes, allowing the flow of blood from one chamber to another and later to the entire body. The person who has a problem with their aortic valve and has a high risk of open-heart surgery are good candidates for TAVI.

Transcatheter Aortic Valve Replacement is recommended to patients who suffer from Aortic Stenosis. Aortic Stenosis is a condition where the opening of the heart's aortic valve is narrowed. This prevents blood flow from the heart to the aorta, then to the other parts of the body since the condition does not allow the heart to open completely. Even though AVS can range from mild to severe, symptoms develop when this condition worsens.

Transcatheter Aortic Valve Implantation

The symptoms include severe chest pain, shortness of breath, rapid increase in heart pulse, and fatigue. If not treated on time, it can even lead to heart failure. Although there are certain medications to treat this condition, proper surgery to replace the aortic valve is the only way through which it can be prevented. Some specialists recommend patients to go through open-heart valve surgery when diagnosed with AVS but in some cases, this surgery can cause further pain in the patient's chest. So, in cases like these, Transcatheter Aortic Valve Replacement is recommended because it can reduce shortness of breath and the risk of heart failure.

How is TAVI procedure conducted ?

TAVI is a surgical procedure performed in an operation theatre. It involves the implantation of new valves made from animal tissues without removing the old and damaged valves. It a beneficiary option for patients who require valve replacement without undergoing massive open-heart surgery.

This surgery is performed via a very small opening, leaving the rest of the chest bones and muscles unaffected.

There are two approaches for performing the surgery. The doctor chooses the best suitable method depending on the patient’s condition and diagnosis

  • Transapical Approach - Via making a small incision in the chest and entering through the largest artery or the apex of the left auricle.
  • Transfemoral Approach - Entering the through femoral artery without requiring any surgical incision in the chest.

What needs to be done Before the TAVI Surgery ?

  • You need to stop taking your usual medications according to your doctor’s consultations.
  • No eating six hours before the surgery.
  • Avoid drinking clear fluid such as water and without milk two hours before the surgery.

Understanding what goes on During the TAVI Procedure ?

  1. A small incision is made in the femoral artery in the groin.
  2. Contrast dye is injected and the procedure is monitored on the X-ray machine.
  3. A catheter, a thin tube-like structure is inserted into the artery and threaded towards the aortic valve.
  4. A catheter-based pace maker is placed on the right side of the heart for controlling the heart rate.
  5. The new valve is guided into the old and damaged valve.
  6. The implant is expanded so that it pins the flaps of the old valve out and takes over.
  7. The catheter and pacemakers are removed after the placement

Post Operative : What happens After TAVI Surgery ?

The doctor will monitor the symptoms of the patient closely. Before discharge, the patient will be given detailed instruction on how to recover properly and faster. It is very important for the patient to follow the instruction and take medicines on time. If the patient continues to feel the signs and symptoms, it is advisable to visit the doctor without any delay.

Risks and Side Effects

Though TAVI is a clinically safe and minimally invasive surgery with a faster rate of recovery, it does involve some risk which can after the health of the patient, like:

  • Kidney Impairment - The contrast dye used for imaging during the surgery have side effects on the kidney, though this risk is reversible in some cases.
  • Arrhythmias - In some cases, during the placement of the valve, the valves press the heart’s electrical system leading to abnormal heart rhythms, requiring a pacemaker.
  • Vascular Injury - In few cases, the blood leaks around the valves due to improper placements, calcium build-up or incomplete expansion of valves.

For TAVI, thus it is very important that one only approaches skilled and experienced doctor. Dr. Rahul Gupta and Team Cardium are well known in India for TAVI in Mumbai / TAVR in Mumbai and have helped countless patients to get back to their routine life without hassle.

What is Surgical Aortic Valve Replacement ? Is TAVI better than SAVR ?

SAVR is an invasive procedure in which a dysfunctional valve is replaced by a healthy valve. This treatment is done when patients suffer from aortic stenosis where the aortic valve opens partially or aortic regurgitation where the aortic valve partially closes, resulting in blood leakage into the heart. In this procedure, the patient is senseless so that it does not react to any pain. An incision is made in the chest where the heart is stopped and a bypass machine takes over the heart's job. The thickened valve is removed and replaced with a healthy one.

For those patients who suffer from coronary heart illness, SAVR is not possible since the chances of heart rupture during this procedure are high. So, instead of surgical, Transcatheter aortic valve replacement is done where a catheter is used to replace the dysfunctional valve instead of replacing it surgically. This procedure is highly recommended since patients have to spend less time in hospitals and they might recover faster.

Benefits of TAVI over SAVR

There are several potential benefits of minimally invasive TAVI surgery. The patient starts feeling better after the surgery. In some cases, the effects might start appearing after a bit longer than usual but all together patients report positive results, such as :

  • Being able to perform daily activities with higher energy.
  • Reduced anxiety
  • Normal breathing
  • Shorter hospital stays
  • Less pain
SAVR TAVR
Treats vascular complications and permanent pacemaker implantations Treats lower risks strokes.
It is an open-heart surgery It is a minimally invasive procedure
Patients who undergo SAVR have more risk for blood transfusion, kidney injury and onset of atrial fibrillation. There are no such complications in TAVR but in some cases vascular complications may occur.

Understanding the Heart and It’s Valves

The heart is one of the most important organs of the body. Its functions are directed by the brain and nervous system which help the body to function normally. It pumps blood to other organs of the body through its valves. The heart has four valves :-

  • Mitral Valve and Tricuspid Valve - Located between the upper and lower chambers of the heart (atria and ventricles). During half of the heartbeat, they let blood flow towards the heart and close so that the blood does not flow backward. There is an exchange of blood flow between the right and left upper heart chambers and the right and left lower heart chambers. Blood flows from the upper right heart chamber to the lower right heart chamber through the open tricuspid valve. The Mitral valve helps in the passage of blood flow through the upper left and the lower left heart chambers.
  • Pulmonic Valve and Aortic Valve - located between the lower heart chambers and blood vessels that leave the heart. They are responsible for transporting blood to other organs of the body. They do this when the lower right chamber closes. Blood is pumped out from it through the pulmonic valve that transports it to the lungs through the pulmonary artery. When the lower-left chamber closes, blood is pumped out and transferred to the arteries through the aortic valve.

Valve Disorders

Valve disorders are difficult to detect. Some may show symptoms like chest pain, blood clots that ensure a disorder, others might not show any. Some of the valve disorders include :-

  • Barlow's Syndrome - causes when the mitral valve does not work properly which results in the blood flowing back to the upper left heart chamber. This is also called Mitral Valve Prolapse and the only treatment for this disorder is replacing the mitral valve.
  • Bicuspid Aortic Valve disease - occurs when the aortic valve has two instead of three flaps. This disorder is present since birth so in some cases, the individual does not even know they have this disease. Symptoms include shortness of breath, chest pain, etc.
  • Valvular Stenosis - occurs when any of the heart valves do not open completely. This prevents blood to flow through the valve which results in the thickening of the valve.
  • Some of the valve disorders take place due to regurgitation or leakage of blood or narrowing of the opening of the valve or stenosis.

Symptoms of aortic stenosis include chest pain, shortness of breath, dizziness and fatigue during strenuous activity, heart palpitations. These are the mild symptoms. If stenosis becomes severe, it leads to heart failure.

Treatment of Severe Aortic Stenosis

In some cases, medications for aortic stenosis are given to reduce blood pressure and heart rate. But if medications do not work, some treatments can be done

  • Aortic Valve Replacement - The dysfunctional aortic valve is replaced by an artificial one that is made of animal skin, metal or it can be a real valve for a donor. This valve replacement is done through open-heart surgery where the rib cage is opened for the treatment to take place.
  • Balloon Valvuloplasty - this treatment is given to infants and teenagers who have aortic stenosis. It is done by inserting a long, flexible tube through a blood vessel into the heart with the tip of the tube attached to a balloon. When the tip reaches the valve, the balloon is inflated which forces the stiff valve to open.
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