TAVI - Transcatheter Aortic Valve Implantation | Doctors & Treatment Information

Aortic valve stenosis is the most common type of heart valve disease. In this condition, the aortic valve—located between the left ventricle and the aorta (the main artery)—is narrowed. As a result, it can no longer open sufficiently. 

As a result, the heart must work very hard to generate the force needed to pump blood throughout the body. The wall of the left ventricle thickens and, as a result, loses its ability to function effectively. 

Those affected experience the following symptoms:

• Increasing chest pain
• Shortness of breath
• Dizziness, or
• General weakness

If the disease is far advanced, it can lead to sudden cardiac death. The only way to treat aortic valve stenosis is to replace the narrowed heart valve. 

This condition cannot be treated with medication. Until a few years ago, such a procedure was only possible under general anesthesia and via open-heart surgery. A heart-lung machine took over the heart’s function during the procedure.

In the TAVI procedure, the surgeon inserts the new heart valve using a catheter. The catheter is inserted through a small incision in the groin.

Initially, the TAVI technique was used only for patients for whom open-heart surgery was too risky. 

More recent data show that even people with a lower surgical risk benefit from the TAVI method: TAVI patients recover faster and experience fewer complications. As a result, heart centers now primarily use the TAVI method.

Comparison of a healthy, calcified, and mechanical aortic valve @ Dee-sign /AdobeStock

During catheter-guided aortic valve implantation, the surgical team inserts a thin, flexible tube—the catheter—into the femoral artery. To do this, the surgeon makes a small incision in the groin. 

At the tip of the catheter is the prosthetic heart valve, which is folded into a small package. This allows it to fit into the artery. For this reason, only biological prostheses can be used in the TAVI procedure. A mechanical heart valve made of metal or plastic cannot be folded up so small.

The doctor then advances the folded heart valve through the artery to the heart. He can guide it to the correct position and slowly unfold it. Once the position and size are correct, he detaches the prosthesis from the catheter. He then withdraws the catheter from the groin.

Unlike open-heart surgery, the TAVI technique does not require general anesthesia. The patient receives only local anesthesia during the procedure.

TAVI (Transcatheter Aortic Valve Implantation) Procedure @ Pepermpron /AdobeStock

Unlike the conventional open-heart procedure, TAVI is a minimally invasive technique. Patients usually recover quite quickly and are mobile again shortly after the procedure. Most patients require hospitalization for only about 5 days. The duration of the subsequent rehabilitation period and whether special measures are required during this time vary from person to person. It’s best to discuss this with your treating physician.

To prevent blood clots from forming after surgery, many doctors prescribe an antithrombotic medication. Some people take such a medication (such as aspirin) for the rest of their lives after the procedure.

Regular follow-up visits are also recommended after the implantation of an artificial heart valve. Cardiology guidelines recommend follow-up visits at three and six months, and then every twelve months thereafter. During these visits, the cardiologist assesses how well the prosthesis is functioning. To do this, they typically perform an ECG and an ultrasound examination of the heart.

As with all medical procedures, a TAVI procedure also carries certain risks. In addition to inflammation or wound-healing complications at the puncture site in the groin, the greatest risk is vascular injury. 

This can occur if the inserted catheter perforates the artery during insertion. Other risks include possible valve leakage after the procedure.

Unlike mechanical heart valves, biological prostheses have a limited lifespan. Therefore, a new heart valve is needed approximately every 15 years.  

This is not the case with a mechanical heart valve following conservative surgery. It can remain in the heart for life. However, a mechanical heart valve requires lifelong use of blood thinners (such as Marcumar). 

Since this, in turn, is associated with several potential complications, the trend is toward biological heart valves despite their limited lifespan.