Post-procedure Care in TAVI
Transcatheter Aortic Valve Implantation (TAVI) is a newly emerging minimally invasive surgical procedure that replaces damaged or narrowed aortic valves in the heart with new valves. The new valve is placed within the diseased valve and is thus sometimes called Transcatheter Aortic Valve Replacement (TAVR).
It is used as a treatment for severe Aortic Stenosis. Aortic stenosis is a condition where the aortic valve becomes very narrow, thus hindering the outflow of blood. It can cause symptoms like chest pain, fatigue, shortness of breath, etc., leading to heart failure or sudden cardiac death
The procedure of TAVI2 is straightforward and is quite similar to placing a stent. There are two methods used to access the aortic valve. Using imaging techniques, a catheter may be passed up the femoral artery in the leg (transfemoral approach), or a small incision in the chest can be used to access large vessels in the chest or the left ventricle of the heart (transapical approach). Once the catheter with the new valve reaches the narrowed aortic valve, a balloon on the catheter’s tip is inflated, and the new valve is appropriately positioned, relieving the narrowing.
There could be procedural complications associated with femoral access, like hematoma formation or retroperitoneal bleeding. Or there could be problems related to the valve itself, like Infective endocarditis, thrombosis and failure of the valve. The procedure can take a toll on the heart and cause conditions like Aortic regurgitation and conduction defects like Left Bundle Branch Blocks (LBBB). Clotting disorders can cause stroke too. There can also be common post-operative conditions like delirium, post-operative pain, renal failure etc.
However, it should be noted that complications3 occur much less frequently in TAVI than the Surgical Aortic Valve Replacement (SAVR), which is much more invasive and is associated with higher morbidity.
Great care needs to be taken after the procedure, as most patients who have undergone TAVI are usually old, frail, and may have many comorbidities. Also, they have to be managed so that the complications, as mentioned earlier, do not occur.
Monitoring is essential. Vital signs, level of awareness, heart murmurs, arrhythmias or cardiac events are constantly monitored. The access site needs to be monitored closely for bleeding and infection. Dressings should be kept clean, dry and intact. Patients at risk of cardiac abnormalities should receive a temporary external pacemaker. Echocardiography should be done after the procedure to check for correct placement. Fluid balance also needs to be adequately maintained.
It is standard procedure for patients to be prescribed antithrombotic therapy to reduce the risk of stroke, heart attack etc. Dual antiplatelet therapy with aspirin and clopidogrel is the current recommendation. Pain management is of utmost importance as well.
The management of the patient’s comorbidities are essential, so regular drugs the patient was on should be resumed early after the procedure.
Another important aspect is patient education. The patient should be told how to identify any possible complications early, as well as diet and activity plans for the upcoming months. They should have regular clinic checkups as well.
If you are in or around Mumbai and think you need to undergo a safe TAVI procedure, don’t hesitate to contact Dr Ankur Phatarpekar. He is an experienced heart specialist in Mumbai who is also regarded as one of the best heart surgeons. If you are from around Mumbai, feel free to visit or check our site to obtain more information about your condition and decide on the best and most effective treatment. Also, you can rest assured that outstanding care will be provided for you if you do undergo TAVI.
- Raiten JM, Gutsche JT, Horak J, Augoustides JG. Critical care management of patients following transcatheter aortic valve replacement. F1000Research. 2013;2. doi:10.12688/f1000research.2-62.v1
- American Heart Association. What is TAVR? (TAVI).
- Aranzulla T, Benedictis M, Asteggiano R. Follow-up management after transcatheter aortic valve implantation (TAVI). Asteggiano . 2016;14.