Introduction to TAVI (Transcatheter Aortic Valve Implantation)

What is TAVI?

Transcatheter Aortic Valve Implantation (TAVI), also known as Transcatheter Aortic Valve Replacement (TAVR), is a minimally invasive procedure used to replace a narrowed aortic valve in patients with severe aortic stenosis (AS). It provides an alternative to traditional open-heart surgery, particularly for patients at high or intermediate surgical risk.

Indications for TAVI

TAVI is primarily indicated for patients with severe symptomatic aortic stenosis who are either: - At high risk for open-heart surgery - Intermediate-risk candidates based on surgical risk assessment - Sometimes considered in low-risk patients, depending on specific clinical characteristics

Symptoms of Aortic Stenosis

Patients who may need TAVI often experience: - Chest pain (angina) - Shortness of breath (dyspnea) - Dizziness or fainting (syncope) - Fatigue and reduced ability to exercise

The TAVI Procedure

TAVI involves the placement of a new artificial valve inside the diseased valve through a catheter. The procedure is typically performed via: - Transfemoral approach – Through the femoral artery in the groin (most common) - Transapical approach – Through a small incision in the chest - Transaortic approach – Via the ascending aorta

The new valve expands and pushes the old diseased valve aside, restoring normal blood flow.

Benefits of TAVI

• Lower procedural risk compared to open-heart surgery
• Shorter hospital stays and faster recovery
• Reduced symptoms and improved quality of life
• Effective for elderly or frail patients who may not tolerate open surgery

Risks and Complications

Like all medical procedures, TAVI has potential risks, including: - Blood vessel complications - Stroke - Valve leakage (paravalvular regurgitation) - Need for a permanent pacemaker - Infection or bleeding

Post-TAVI Care

After the procedure, patients typically need: - Regular follow-up with a cardiologist - Anticoagulation therapy if indicated - Lifestyle adjustments, including a heart-healthy diet and exercise

Conclusion

TAVI is a revolutionary procedure that has transformed the treatment of severe aortic stenosis. It is especially beneficial for high-risk patients who are not good candidates for open-heart surgery. Discuss with your cardiologist whether TAVI is an appropriate option for you.

Source recommendations

1. American College of Cardiology/American Heart Association Guidelines for the Management of Patients With Valvular Heart Disease

1. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2024/03/13/18/13/2024-acc-aha-clinical-performance-valvular
2. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923
3. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2020/12/16/21/58/2020-ACC-AHA-VHD-GL-Pt-1-GL-VHD
4. https://pubmed.ncbi.nlm.nih.gov/9809971/
5. https://professional.heart.org/en/science-news/2020-acc-aha-guideline-for-the-management-of-patients-with-valvular-heart-disease

2. European Society of Cardiology Guidelines for the Management of Valvular Heart Disease

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Valvular-Heart-Disease-Guidelines
2. https://academic.oup.com/eurheartj/article/43/7/561/6358470
3. https://pubmed.ncbi.nlm.nih.gov/34453165/
4. https://eurointervention.pcronline.com/article/2021-esc-eacts-guidelines-for-the-management-of-valvular-heart-disease
5. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923