TAVI - Transcatheter aortic valve implantation | Doctors & treatment information

For which clinical picture is TAVI used?

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

As a result, the heart can only muster the strength to pump blood into the body with great effort. The wall of the left ventricle thickens and consequently loses its efficiency.

Those affected feel this through

• Increasing chest pain
• shortness of breath
• Dizziness or
• General poor performance

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

This disease cannot be treatedwith medication. Until a few years ago, such an operation was only possible under general anesthesia and with an open heart. A heart-lung machine took over the heart function.

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

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

More recent data shows that people with a lower surgical risk also benefit from the TAVI method: TAVI patients recover faster and have fewer complications. This is why heart centers today mainly use the TAVI method.

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

How does the procedure work?

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 heart valve prosthesis, which is folded up 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 into such a small package.

The doctor then pushes the folded heart valve through the artery to the heart. He can push it to the correct position and slowly unfold it. If the position and size are correct, he disconnects the prosthesis from the catheter. He then pulls the tube out of the groin again.

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

Procedure for TAVI (transcatheter aortic valve implantation) @ Pepermpron /AdobeStock

After the procedure: aftercare

Unlike the conventional open heart procedure, TAVI is a less invasive technique. Patients usually recover quite quickly and are mobile again shortly after the procedure. Most patients only require inpatient treatment for around 5 days. How long the subsequent rehabilitation period lasts and whether special measures are required during this time depends on the individual. It is best to discuss this with your attending physician.

To prevent blood clots from forming after the operation, many doctors prescribe antithrombotic medication. Some people take such a preparation (e.g. ASA) for the rest of their lives after the operation.

Regular follow-up examinations are also recommended after the insertion of an artificial heart valve. The cardiology guidelines recommend check-ups after three, six and then every twelve months. During these examinations, the cardiologist checks the extent to which the prosthesis is fulfilling its function. To do this, he usually carries out an ECG and an ultrasound examination of the heart.

What are the risks, complications and disadvantages?

As with all medical procedures, there are certain risks associated with a TAVI procedure . In addition to inflammation or wound healing disorders at the insertion site in the groin, the greatest risk is vascular injury.

This can be caused by the inserted catheter if it perforates the artery during insertion. Other risks include possible valve leakage after the procedure.

Unlike mechanical heart valves, biological prostheses have a limited shelf life. A new heart valve is therefore required approximately every 15 years.

This is not the case with a mechanical heart valve after conservative surgery. It can remain in the heart for life. However, with a mechanical heart valve, it is necessary to take blood thinners (such as Marcumar) for the rest of your life.

As this in turn is associated with a number of possible complications, the trend is moving towards biological heart valves despite their limited durability.