TAVI (Transcatheter Aortic Valve Implantation)

TAVI (Transcatheter Aortic Valve Implantation)

TAVI (transcatheter aortic valve implantation) is a non-surgical, minimally invasive procedure to replace a narrowed aortic valve with an artificial aortic valve using a trans-vascular approach without the need for surgery. TAVI involves inserting an intravascular catheter through the groin (transfemoral), the apex of the heart (transapical), or the arch of the aorta (transaortic) to the aortic valve stenosis, allowing the artificial aortic valve to unfold from the delivery system, expand, and become a new aortic heart valve, replacing a stenotic aortic heart valve without surgery. TAVI is ideal for the elderly with severe aortic valve stenosis who are unsuitable for open chest surgery as it leaves no surgical wounds, reducing the risks and complications of the surgery, allowing patients to recover quickly, and enabling them to live their lives to the fullest extent.

Why TAVI?

Typically, cardiologists treat those with aortic valve stenosis with medication and open-heart surgery with a large incision to remove aortic valve stenosis and sew in the artificial heart valve to replace the defective one. However, cardiologists later found open-heart surgery is too risky and unsuitable for the elderly, including those with physical vulnerabilities, and those with multiple congenital anomalies due to their frailty, which may cause them to not withstand the prolonged use of anesthesia and 3-4 hours of surgery that may lead to unexpected life-threatening outcomes.

TAVI (transcatheter aortic valve implantation) is a new medical innovation for treating aortic valve stenosis, replacing conventional open-heart surgery without the need for anesthesia and a heart-lung bypass machine. TAVI does not leave a large surgical wound in the middle of the chest; instead, the procedure leaves only a 1 cm. tiny puncture wound in the groin, the apex of the heart, or the arch of the aorta. In addition, the procedure takes only 1-2 hours, and the recovery time at home is approximately 1-3 weeks. After a full recovery, patients can resume their normal activities as usual.

What causes aortic valve stenosis?

Aortic valve stenosis is caused by a deteriorative valve when aging, aortic valve regurgitation or bicuspid aortic valve, and calcified plaque, including lipid, accumulated on the heart valves in large quantities, commonly found in aortic valves, an open-close tissue located between the left ventricle and the aorta, resulting in the heart valves narrowing and inadequately pumping blood to supply various parts of the body, forcing the heart to work harder, have more contractions, and require more oxygen. This causes the heart valves to thicken and harden in order to maintain a steady contraction rhythm but a slower relaxation. As a result, patients may experience chest pain, fatigue, difficulty breathing, dizziness, fainting, and unconsciousness. If not treated early, the aortic valve will gradually thicken and decrease flexibility when opening and closing, leading to heart failure or a heart attack, which can be life-threatening.

What are the symptoms of aortic valve stenosis?

• Chest pain, chest tightness, angina
• shortness of breath, difficulty breathing.
• Fatigue, tiredness, and exhaustion when exerting or exercising.
• Heart palpitations, heart murmurs (when the doctor listens through a stethoscope)
• Feeling dizzy, lightheaded, fainting.
• Swollen feet and ankles.
• Fainting, loss of consciousness.
• Heart failure, heart attack.

What is the diagnosis before TAVI?

Cardiologists will diagnose aortic valve stenosis before determining TAVI by taking a medical history and performing a physical examination, followed by specific imaging tests to determine the severity of the narrowed aortic valve. If the aortic valve test results reveal severe aortic valve stenosis and the patient is not suitable for surgery. The cardiologist will recommend TAVI, a minimally invasive transcatheter aortic valve implantation.

Candidates for TAVI (transcatheter aortic valve implantation)

• Chest pain, fatigue, shortness of breath, heart palpitations, dizziness, fainting, and frequently losing consciousness.
• Elderly aged 75 years and up who have been diagnosed by a cardiologist for severe aortic valve stenosis.
• Have a history of aortic valve stenosis, aortic regurgitation, or bicuspid aortic valves.
• Physically frail or suffering from multiple comorbid diseases, such as aortic stenosis or lung disease.
• Has had previous heart surgery.

Blood Tests

• Complete blood count (CBC): measures blood cell platelets, checks blood clotting, measures kidney function, and checks for other abnormalities such as diabetes, kidney disease, and high blood lipids.

Heart Screening Tests such as:

• Electrocardiogram (EKG/ECG)
• Echocardiogram
• Exercise Stress Test (EST)
• CT Coronary Angiogram
• Coronary angiogram (CAG)

What is a TAVI (Transcatheter Aortic Valve Implantation) procedure?

TAVI (transcatheter aortic valve implantation) at MedPark Hospital adheres to international standards in treating aortic valve stenosis, prioritizing the utmost safety and treatment success outcomes to allow the patient relief from symptoms related to aortic valve stenosis and to resume their daily activities as fast as possible.

Preoperative TAVI Procedure

• Patients undergoing TAVI are advised to stop taking antiplatelets such as aspirin or warfarin, *except for certain medications approved by the cardiologist.
• Patients with a history of drug allergies *must* notify the cardiologist in advance.
• Refrain from eating for at least 6 hours and drinking for at least 2 hours before the procedure.

Intraoperative TAVI Procedure

• The cardiac interventionist administered local anesthesia to sedate the sensation. The patient will remain conscious throughout the procedure but not feel any pain. Except for some patients, the doctor may administer IV anesthesia to put them asleep during the procedure.
• The cardiac interventionist will puncture and thread an intravascular catheter through the groin (transfemoral), the apex of the heart (transapical), or the arch of the aorta (transaortic) to the aortic valve. The cardiac interventionist then releases the tissue-like artificial aortic valve attached to the tip of the catheter to unfold from the delivery system and expand like a balloon to become a new aortic heart valve, replacing the old degenerative one, reactivating the normal opening and closing of the aortic heart valve leaflets to fully function, allowing blood to circulate throughout the body, and gradually relieving chest pain and aortic valve stenosis-related symptoms.
• Upon completing the transcatheter aortic valve implantation procedure, the cardiac interventionist will gently pull the catheter back and apply direct pressure to the artery puncture wound to stop bleeding without suturing. The TAVI procedure typically takes approximately 1-2 hours.
• Cardiologists, nurses, and medical staff will periodically monitor vital signs, including blood pressure, pulse, and respiratory rate, to ensure the patient is safe and comfortable.

Postoperative TAVI Procedure

• The patient lies supine in bed and refrains from sitting, walking, and flexing the groin for 6–10 hours to prevent bleeding.
• Patients are advised to stay overnight in the hospital for 1-3 days of observation, depending on their physical condition.
• Patients are encouraged to participate in a cardiac rehabilitation program, which includes monitored exercise, dietary changes, and lifestyle modifications.
• If the treatment outcomes are good without any complications, the cardiologist will release the patient from the hospital to continue to recover at home.
• The cardiologist will schedule appointments periodically to monitor symptoms and assess treatment outcomes until the patient fully recovers.

What is a TAVI aftercare

• After the treatment, patients must take blood thinners for 3 months and attend all cardiologist's appointments.
• Exercise regularly as recommended by the cardiologist, such as taking short walks, to aid a quick recovery.
• Refrain from strenuous activities and exercise; refrain from lifting heavy objects for 2-3 weeks and driving for 4 weeks.
• Stop smoking, exercise regularly, eat nutrients and low-sodium foods, and avoid foods containing trans fats.

What are the risks and complications of TAVI?

TAVI (transcatheter aortic valve implantation) risks and complications include bleeding on the puncture site, blood clots under the skin, heart arrhythmia (cardiologists may consider a heart pacemaker), stroke, kidney impairment (the kidneys are unable to excrete contrast dye from the body), the artificial heart valve dislodging out of position, myocardial infarction, or death. However, these complications occur at a very low rate (less than 5%). Compared to other treatment methods, TAVI has superior treatment outcomes with a very low risk and is regarded as an effective medical procedure that can significantly save patients' lives.

What is the benefit of TAVI?

• No surgery, no scars, and no anesthesia.
• Tiny incision, less pain, and less damage to surrounding tissue.
• Scant blood loss: no internal organs injured.
• Low risk, few complications
• Short procedural time of only 1-2 hours.
• Cost-effectiveness, reduced length of hospital stays.
• Short recovery time of only 3 months.
• Suitable for the elderly, frailty, underlying diseases
• Treatment efficacy is comparable to surgery.
• Improved quality of life.
• Prolonged life expectancy.

What is the success rate of TAVI?

According to the studies, individuals who were treated for heart valve stenosis with transcatheter aortic valve implantation (TAVI) had a significantly lower death rate, a shorter length of hospital stay, a shorter recovery time at home, a lower rate of hospitalization, and a significant reduction in aortic valve stenosis symptoms. The new aortic valve can continuously function for up to 10 years or more, depending on regular health practices as advised by the cardiologists.

TAVI at MedPark Hospital

Cardiology Center at MedPark Hospital is led by a team of experienced cardiologists who are ready to provide top-notch diagnosis and treatment to treat difficult and complex aortic valve stenosis, aortic valve regurgitation, or bicuspid aortic valve with standard open-heart surgery or innovative minimally invasive transcatheter aortic valve implantation (TAVI), using state-of-the-art medical technology and equipment integrated with precision advanced medical techniques, entailing utmost safety and aiding in the treatment efficiency. MedPark cardiac rehabilitation program is catered by a multidisciplinary team to provide consistent postoperative care to ensure patients are free of complications and enable quick recovery, good physical health, and long-life expectancy.