Why Modern Heart Valve Treatments Are Becoming Increasingly Minimally Invasive

The aortic valve is located between the left ventricle and the aorta. It opens with every heartbeat and ensures that oxygen-rich blood is pumped into the body. It then closes again to prevent blood from flowing backward.

As people age, calcium deposits can form on the aortic valve. This causes the valve to lose flexibility and prevents it from opening fully. The heart must work much harder to pump blood through the narrowed opening.

Over time, this increased strain can damage the heart muscle and lead to heart failure. 

The condition usually develops gradually. Many people affected initially notice no symptoms or only mild ones. However, as the heart valve becomes increasingly narrowed, the symptoms often worsen.

Typical signs include:

• Shortness of breath during physical exertion
• Chest pain or a feeling of pressure
• Dizziness
• Fainting spells
• Reduced stamina
• Rapid exhaustion
• Heart palpitations

If these symptoms occur in conjunction with severe aortic valve stenosis, treatment should not be unnecessarily delayed. 

A doctor can already detect signs of a narrowed heart valve by listening to the heart. However, the most important test is echocardiography (heart ultrasound). It shows how severely the valve is narrowed and how well the heart is still functioning.

Depending on the specific situation, an electrocardiogram (ECG), stress tests, computed tomography (CT), or a cardiac catheterization may also be used. Before a planned TAVI, computed tomography in particular provides important information about the anatomy of the heart valve and blood vessels. 

The abbreviation TAVI stands for transcatheter aortic valve implantation. In this procedure, the diseased heart valve is not surgically removed but is replaced with a biological prosthetic heart valve, which is delivered to its location via a catheter. In most cases, access is gained via the femoral artery. The new heart valve is advanced through the catheter to the heart in a folded state and then precisely unfolded within the diseased valve. The calcified heart valve is pushed to the side, and the new valve immediately begins to function.

Since neither the chest needs to be opened nor the heart stopped, TAVI is considered significantly less invasive than traditional open-heart surgery.

Whether a TAVI or traditional open-heart surgery is more suitable depends on various factors. These include, among others, age, comorbidities, the anatomy of the heart valve, and the individual’s surgical risk.

TAVI is often suitable for:

• older patients
• People with an increased surgical risk
• Patients with multiple underlying medical conditions
• selected individuals with moderate or low surgical risk

Today, the decision is generally made jointly by an interdisciplinary cardiac team consisting of cardiologists and cardiac surgeons. 

TAVI has established itself as a safe and effective procedure in recent years. Many patients benefit from a faster recovery and rapid improvement in their symptoms.

Among the most important advantages are:

• no major incision in the chest
• a shorter hospital stay in most cases
• faster mobilization
• less physical strain
• rapid improvement in exercise tolerance
• High success rates 

Like any medical treatment, TAVI also carries risks. These include, among others, bleeding, vascular injuries, cardiac arrhythmias, or strokes. In some cases, a pacemaker may need to be implanted after the procedure.

However, thanks to modern valve systems, improved imaging, and the extensive experience of the treating centers, these risks have been significantly reduced in recent years. 

After a successful TAVI, most patients spend a short time in a monitoring unit. Often, they can resume cautious physical activity just a few hours or days later.

Regular follow-up visits with a cardiologist are important to monitor the long-term function of the new heart valve. In addition, anticoagulant medications are adjusted, and risk factors such as high blood pressure or diabetes are treated. 

TAVI has fundamentally changed the treatment of aortic valve stenosis and enables many patients to undergo heart valve replacement without open-heart surgery. This minimally invasive catheter procedure offers an effective and safe treatment option, particularly for older adults or patients with an increased surgical risk. Thanks to modern technology, thorough diagnostics, and close collaboration among specialized cardiac teams, excellent treatment outcomes can be achieved today. Anyone experiencing shortness of breath, dizziness, or chest pain should have these symptoms evaluated by a cardiologist as soon as possible so that a narrowed heart valve can be detected and treated in a timely manner.