Complications with the aortic valve are increasing in people across the world. Under normal conditions, this valve opens up when blood is pumped from the heart to various parts of the body. However, sometimes the aortic valve cannot open and close in a proper fashion and blood flow is hampered as the valve becomes stiff. This condition is known as aortic stenosis. It is obvious that when this happens, extra pressure is exerted on the heart, as blood is pumped through a small valve opening. Swollen ankles, dizziness, breathlessness, chest pain and even blackouts in some cases, are a few of the symptoms.
Generally in cases like this, open-heart valve surgery is recommended. But this treatment isn’t always suitable for all kinds of patients. Older patients, those who are too ill or those who have various other kinds of medical issues might not be able to undertake open-heart valve surgery as it will be too risky for them. Transcatheter aortic valve implantation is the treatment procedure that works in cases like this.
Transcatheter aortic valve implantation is a procedure where an aortic valve is implanted with the use of a long narrow tube, known as a catheter. In general, the catheter is inserted into a large blood vessel in the groin or through a small incision which is made in the chest of the patient.
Special transcatheter aortic valves are designed for surgical purposes. Natural tissue from the heart of either pig or cow is used for making the valve, which will then be implanted in the patient. Re-engineered, the natural tissue is then attached to a flexible and expandable mesh frame. For implanting the valve to the heart, the valve is squeezed inside or around the catheter. The catheter is then inserted and guided to the location of the aortic valve opening in the heart. After the implantation of the new valve, over the existing valve, the catheter is removed. The working of the new valve starts immediately after implantatio
Patients who suffer from progressive heart failure due to aortic stenosis, but are not fit for traditional open-heart aortic valve replacement surgery will need TAVI. Here are some of the conditions in which open-heart surgery might prove to be dangerous:
- Advanced age
- History of stroke
- Weak heart
- Kidney ailment
- Chronic obstructive lung disease (COPD)
- Previous heart surgery
Calcium deposits in blood vessels, which carries blood from the heart to other parts of the body
The surgical and medical team will first ascertain the overall health of the patient. The doctor will carry out various kinds of tests and investigations on the patient to understand better if they will benefit from the TAVI procedure. Some of the tests include blood tests, x-rays, CT scans, electrocardiograms, echocardiogram and so on. With an echocardiogram, it is possible to create images of the heart for evaluating the aortic valve. For some patients, cardiac catheterization might also be done, in order to evaluate the heart. Other preparations, which need to be taken include:
- Informing the doctor about all the medicines that you take, including over the counter medicines
- If you smoke, ask the doctor how soon should you quit before the surgery
- In case the doctor asks you to stop certain medicines, do that as per instruction
- Don’t eat and drink after midnight, before the surgery
The methods sometimes vary depending on the condition of the patient and on the practice that the doctor follows. This is generally the procedure that is followed:
- The patient needs to be admitted to the hospital the day before the surgery or on the morning of the surgery date.
- On the arm or hand, an intravenous (IV) line will be started. Additional catheters are inserted in the wrist and neck for monitoring the status of blood pressure and heart.
- In the operation theater, you will be made to lie on your back.
- The anesthetist will monitor blood pressure, heart rate, blood oxygen level and breathing during the surgery. Once anesthesia is applied, a breathing tube is inserted into the trachea so that the lungs get oxygen. A connection to the ventilator is also established which regulates breathing during the surgery.
- A catheter is inserted into the bladder for draining urine.
- A Transesophageal echocardiogram (TEE) probe is inserted in the esophagus for helping in visualizing the valve.
- An incision is made in the groin area for locating the femoral artery. This artery helps in carrying blood from the heart to the leg below.
- A catheter is placed into the artery and threaded to the heart through the aorta for reaching the aortic valve.
- Other catheters are also placed in the heart for taking x-ray pictures and measurements during the procedure.
- The replacement valve is guided, which is inside an expandable balloon, up into the femoral artery catheter and through the old aortic valve.
- Once the balloon is positioned properly, the cardiologist expands it and implants the new valve for replacing the old one.
- Before removing the catheters, the doctor will check that the new valve is working properly by monitoring the same and by taking frequent pictures of the same.
- The femoral artery and the groin incision will then be closed with clips or sutures.
After the surgery, the patient is moved to the intensive care unit of the hospital so that they can be monitored all the time during recovery. As the recovery process continues, the various tubes in the arteries and veins are removed gradually. The hospital stay will continue for a few days. But normal diets can be resume quickly.
Once the patient is home, which happens after a few days, depending on the speed of recovery, they must follow all the instructions regarding medicines, diet, pain control, activity and wound care. Also, maintain all the follow-up appointments.
It might take a few weeks to recover completely.
Mentioned below are some guidelines, which will help in quick healing:
- After a TAVI, the doctor recommends blood-thinning medicine for preventing blood clots. For ensuring that you are getting the right dose, you must have your blood checked regularly.
- Make sure that you walk as much as possible.
- Refrain from lifting anything heavy, but you can do other normal activities.
- Ask permission from your doctor as to when you can indulge in rigorous working, driving or any kind of sexual activity.
- Inform the doctor immediately if there is any kind of pain, bleeding, fever or shortness of breath.
- Keep a close watch on the groin area for any sign of redness, swelling, discharge or bleeding.
- Maintain a healthy weight.
- Eat a heart-healthy diet.
- Refrain from smoking.
More and more cardiologists are getting experience with TAVI and the risks associated with the same are decreasing. However, TAVI is a major procedure in which general anesthesia is required. Some of the common risks which are closely associated with TAVI include the following:
- Damage to the blood vessels
- Heart attack
- Lung puncture
- Stroke because of decreased blood supply to the brain
- Kidney failure
- Replacement valve failure
- Fluid collection around the heart
- Severe heart failure
There might be other risks as well depending on your health condition. Before the procedure have a detailed discussion with your doctor on these matters.
When handled by a good cardiologist and proper following of instructions, patients undergoing TAVI recover quickly.