Aortic valve repair and replacement are procedures that treat diseases that affect the aortic valve (one of the four valves that control blood flow through the heart).
The aortic valve keeps blood flow in the correct direction from the heart. It separates the main pumping chamber of the heart (the left ventricle) and the main artery that supplies blood to the body (aorta).
With each contraction of the ventricle, the aortic valve opens and allows blood to flow from the heart into the aorta, then the aortic valve closes and prevents blood from returning to the heart.
When the aortic valve becomes diseased (stenosis or insufficiency), it can impede adequate blood flow and deteriorate heart function, putting the patient's life at risk.
By repairing or replacing the aortic valve, diseases of the aortic valve can be treated and its proper function restored, improving symptoms, prolonging life, and preserving the function of the heart muscle.
What is TAVI (or TAVR)?
TAVI or TAVR stands for Transcatheter Aortic Valve Implantation or Replacement. During this process, a new heart valve is inserted without surgery, through a catheter, without removing the previous damaged valve. The new valve is placed inside the diseased valve.
The TAVI method, similar to stent placement in a coronary artery, delivers a replacement foldable valve to the site of the diseased valve via a catheter. Once the new valve expands, it pushes against the flaps of the old valve. Then the replacement valve is responsible for regulating blood flow from the heart to the general circulation (function of the diseased native aortic valve).
Procedure
The TAVI procedure is done by one of several methods. The cardiology team selects the method that provides the most appropriate and safe way to access and treat the valve:
- Enter through the femoral artery, which is known as the transfemoral method (most used access)
- Use a minimally invasive method by making a small incision in the chest and entering through a large artery in the chest, known as the transaortic or subclavian method, or through the tip of the left ventricle (the apex), known as the transapical method.
After local anesthesia (in most cases) in the puncture area, catheters are introduced through the arteries, directing them to the heart. Once there, the valve prosthesis is implanted, which is introduced with the help of a guide, releasing it over the patient's diseased aortic valve.
The correct performance of the entire procedure and placement of the valve is confirmed through different imaging techniques and contrast injection at the level of the aorta immediately above the prosthesis.
Who is a good candidate for this type of valve?
TAVI was originally approved only for patients who were too sick to undergo open heart surgery.
The latest round of TAVI indications to include moderate-risk patients has significantly increased the number of patients with aortic stenosis who are candidates for TAVI. Additionally, trials to determine the effectiveness of TAVI in low-risk patients are already underway.
Recovery
With TAVI, open heart surgery is avoided, so recovery and hospital discharge times are considerably shorter.
CONCLUSION
TAVI may be an effective option to prolong and improve quality of life for patients with aortic valve diseases who would otherwise have limited alternatives for valve repair. The definitive treatment of aortic valve disease in a given patient must be carried out in conjunction with the cardiology team to choose the technique (TAVI, surgery, medical treatment) with the lowest risk and greatest benefits for the patient.
By Dr. J. Frank Sliwinski
The UICAR Valvular Heart Disease Unit assesses the treatment of aortic valve disease.