Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive surgical procedure used in the treatment of aortic valve stenosis. Aortic valve stenosis occurs when the aortic valve, the heart's main outlet, narrows or hardens, preventing the heart from pumping blood effectively. Traditionally, open-heart surgery is required to treat aortic valve stenosis. However, for some patients, surgical intervention is risky or unsuitable. Therefore, the TAVI method provides an alternative for these patients and offers a life-saving option, especially for the elderly population. Clinical studies conducted in recent years have shown that the TAVI method can also be safely applied to patients with intermediate and low surgical risk, and its scope of application has expanded significantly.
Working Principle of TAVI
In the TAVI procedure, a biological or mechanical prosthetic valve is placed in place of the narrowed and dysfunctional aortic valve. This procedure is performed via a catheter system without opening the chest. The new valve is placed at the tip of the catheter in a compressed state and is delivered to the heart through a blood vessel in the groin or chest area. It is deployed inside the old valve with the help of a balloon or by self-expansion and begins to function immediately. The entire procedure is performed under the guidance of fluoroscopy and echocardiography. The valve models used are bioprosthetic valves made from bovine or porcine pericardium and can be used durably for many years.
Conditions Treated
Severe Aortic Stenosis
TAVI is one of the primary treatment options for patients with severely narrowed aortic valve area who are symptomatic. Patients with complaints such as shortness of breath, chest pain, and fainting spells benefit greatly from this procedure. Since life expectancy is quite short in untreated severe aortic stenosis, timely TAVI is life-saving.
High Surgical Risk Patients
TAVI is the ideal option for patients for whom open-heart surgery carries a high risk due to advanced age, accompanying serious illnesses, previous heart surgery, or lung disease. For patients with chronic kidney failure, advanced heart failure, or a history of malignancy, TAVI significantly improves quality of life when open surgery is not possible.
Bioprosthetic Valve Failure
In cases where previously implanted bioprosthetic valves wear out over time, a new TAVI valve can be placed inside the old one using a method called "valve-in-valve." This method allows for avoiding a second open-heart surgery and offers a much less traumatic treatment option for the patient.
Patients Unsuitable for Surgery
In some patients, surgical treatment is not suitable due to advanced pulmonary disease, a history of malignancy, or poor general condition. In these patients, TAVI may be the only treatment option. It offers hope to patients who would otherwise be limited to medical treatment.
Intermediate Surgical Risk Patients
As shown by recent large-scale studies, TAVI results in intermediate surgical risk patients can be comparable to or better than open surgery. Therefore, the indication area is gradually expanding.
Steps of the TAVI Procedure
Catheter Access
The procedure usually begins with the insertion of a catheter through a small incision into an artery in the groin (femoral artery) or an artery in the chest area (subclavian artery). This catheter carries the prosthesis to be used for the new valve. Depending on anatomical suitability, transapical or direct aortic approaches can also be used. Vessel diameter and calcification status are evaluated with CT angiography before the procedure.
Prosthetic Placement
The catheter is advanced while the patient is under general anesthesia or sedation, and the new prosthetic valve is placed in the position of the narrowed aortic valve. The prosthesis is usually expanded with the help of a balloon and fixed in place. Self-expanding valve models are also available, and the most suitable valve for the patient is selected. For ideal placement, the heart is temporarily kept motionless by rapid ventricular pacing.
Imaging and Evaluation
Imaging techniques such as fluoroscopy or echocardiography are used to verify that the prosthesis is correctly positioned and functional. It is evaluated whether the new valve is leaking and whether it is working properly. If necessary, additional balloon expansion is performed, and final control images are taken.
Advantages of TAVI
- Minimally invasive: Requires smaller incisions compared to open-heart surgery, which means less tissue damage and a faster recovery time.
- Lower risk of complications: The risk of complications associated with open-heart surgery is lower because the TAVI procedure is usually performed under sedation rather than general anesthesia, and the heart is not stopped.
- Faster recovery: Patients generally recover faster and have shorter hospital stays.
- Suitability for elderly patients: Can be safely applied even in advanced age patients.
- Significant increase in quality of life: Complaints of shortness of breath and chest pain improve in a short time.
- Early mobilization: Patients can usually stand up on the first day after the procedure.
- Low risk of stroke: The risk of stroke has been significantly reduced with new-generation devices.
- Repeatable procedure: Can be reapplied using the valve-in-valve method when necessary.
Treatment Process
A detailed evaluation process is carried out before TAVI. The heart and vascular structure are examined with echocardiography, CT angiography, and coronary angiography. Aortic valve area, valve annulus size, coronary ostia heights, and suitability for vascular access are evaluated. The patient's suitability for TAVI is assessed by a multidisciplinary heart team, and the appropriate valve size is determined. The procedure usually takes one to two hours and is performed under sedation. The patient stays in the intensive care unit for one day after the procedure and is discharged within three to five days in total. A close follow-up program is applied in the first month after discharge. Valve function is monitored with regular echocardiography.
Points to Consider
TAVI can be an effective option for suitable patients in the treatment of aortic valve stenosis. However, it may not be suitable for every patient, and the treatment option should be determined based on the patient's general health status and other factors. Blood-thinning medication must be used for a certain period after the procedure. Antibiotic prophylaxis is recommended before dental treatments. Valve function is evaluated with regular cardiology check-ups. Excessive physical activity should be avoided for the first few weeks, and the exercise program recommended by the doctor should be followed. Arrhythmia may develop after the procedure, and a permanent pacemaker may be required; this situation is discussed with the patient in advance. Regular use of anticoagulant and antiplatelet drugs prevents the risk of endocarditis and thrombus. Attention should be paid to wound site control and general hygiene.
As Koru Hospital, we continue to be a source of hope for our patients with aortic valve disease with our experienced cardiology and cardiovascular surgery team and our state-of-the-art TAVI facilities. We aim to increase the life expectancy and quality of our high-risk patients by offering safe and effective treatment options.
