The Transcatheter Aortic Valve Implantation (TAVI) method has been developed to replace the aortic valve with the aid of a catheter and is an alternative to surgical intervention. The method is also called non-surgical aortic valve replacement. While it was being performed in patients with high risk of surgery in its early years, TAVI can now be considered in patients with moderate or even low-surgical risk to replace the aortic valve. The biggest advantage compared to the surgical method is that the chest is not opened and thus, a shorter recovery time is provided.
The Aortic Valve and TAVI
The aortic valve is the valve located between the main pumping chamber of heart (left ventricle) and the main artery to your body (aorta) and it may become severely narrowed due to congenital anomaly or calcification in advanced ages. In this case, an intervention is required for recovering its function. In the past, surgical intervention was the only method to open the chest and intervene in the aortic valve, but today the TAVI method is becoming increasingly common.
Advantages of TAVI
Compared to traditional or open surgical methods, TAVI is preferred because it is performed with less invasive intervention and less incision in the body. In addition, the TAVI method allows patients with a high risk of operation to undergo surgery. The fact that general anesthesia is not required in TAVI operation allows aortic valve changes in patients who have problems in operating due to anesthesia. When TAVI is performed with laparoscopic methods, it also gives all the advantages of laparoscopic surgery. The TAVI method is more advantageous than the traditional open surgery method, especially in patients who are elderly, have other serious health conditions, are not suitable for general anesthesia or have a fear of anesthesia, and in patients who have cosmetic problems with surgical incisions. In addition, TAVI reduces operation durations, follow up terms and post operation complaints.
Before TAVI, it is determined whether the patient is suitable for the method. Society of Thoracic Surgeons-STS values are calculated for this evaluation. Patients with a risk assessment of 10% or more for STS have a high surgical risk. On the other hand, although there are studies suggesting that there are not enough studies for young patients and therefore caution should be exercised, the method is becoming increasingly common in all age groups. Supporting clinical results with scientific publications also show that the method is becoming more advantageous than the surgical method for all age ranges.
In the TAVI method, the patient is often given a mild reliever drug or sedation. Then, the aortic valve is reached with a tube (catheter) from the groin artery of the patient. In cases where it is not possible to enter from the groin area or there is occlusion in the arteries in the abdomen, an incision of about 3 cm is made on the left chest wall and the valve is reached. In addition, the patient is not taken into general anesthesia. For this reason, there is no anesthesia, postoperative scar formation, scars or cuts caused by surgical intervention in valve replacement with TAVI method. The majority of studies report that patients do not have pain during and after the TAVI procedure. TAVI is an operation with a short application time and a short discharge time. TAVI lasts for one hour and patients are usually discharged in 3 days after being kept under control.
Patient Age and TAVI
Although it is applied more frequently to elderly patients today, there are studies reporting that more experience is needed in younger patients. In addition, there are studies reporting that TAVI method can be preferred in young patients when compared to the surgical method.
Complications and Side Effects of TAVI
Since there is no general anesthesia and no surgical incision in TAVI procedure, post-procedural complications are minimal. Although rare, post-procedure stroke, bleeding, or adverse conditions at the site of entry during the procedure have been reported. There are few studies reporting results such as irregular heart rhythm and kidney damage. For this reason, the experience and ability of the specialist who performs the operation becomes important. Since the equipment used has the latest technology, these potential unfavorable effects seen after the procedure are minimized today.
On the other hand, in current clinical studies, it is reported that many conditions associated with TAVI in the past are not actually related to TAVI. In a study conducted in 2021, it was reported that baseline anemia levels were not associated with long-term mortality after TAVI. In another study, TAVI results in public and private hospitals were compared and it was reported that the procedure was safe and that the certain complications were due to the incapabilities of the public hospitals. With an experienced team and adequate equipment, the method becomes highly effective and safe.
It is useful to follow up the patient for aortic valve function after TAVI, the level of adaptation to the body, and if there occur any complications. Generally, patients are kept under observation for one night after TAVI, followed by controls for the first month, three, six and nine months.
Although TAVI is applied in every age range today, aortic valve problem usually occurs in advanced ages and there are many accompanying diseases in advanced ages. In this regard, although TAVI allows the aortic valve to change in a way that minimizes interaction with concomitant diseases, routine controls should be followed, ongoing follow-ups in other services (such as hypertension, diabetes) and other physicians should be informed, especially in elderly patients.
After the TAVI operation, the doctor’s instructions, warnings, diet and physical exercise restrictions should be followed carefully. Generally, these restrictions or guidelines such as diet are not directly related to the TAVI procedure, but are the living standards that must be followed for the health of the aortic valve. Aortic valve, or more generally, a condition that negatively affects the heart health of the patient is important for the health of the patient after TAVI application. For this reason, the physician can guide the patient towards the factors affecting the heart health of the patient after TAVI, so that the gains obtained after TAVI may be sustained in the longer term.