TAVI

Transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement (TAVR) is a minimally-invasive heart procedure performed to repair a damaged aortic valve.

The aortic valve is one of the four heart valves that is located between the lower-left heart chamber, known as the left ventricle, and the main artery of the heart, known as the aorta.

Aortic valve stenosis is a condition that occurs when the aortic valve of the heart thickens and calcifies (becomes stiff) causing the valve to not open fully and leading to a reduced blood flow to the body.

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Purpose:

  • TAVI procedure is a minimally-invasive procedure done to treat aortic valve stenosis.
  • TAVI is an alternative to open-heart surgery which is an invasive procedure, and is recommended in the following cases:
  • Severe aortic stenosis leading to various symptoms.
  • Presence of other health disorders, like lung or kidney disease, which makes open-heart valve replacement surgery extremely risky.
  • Presence of a biological tissue aortic valve (an artificial valve made of human or animal tissue) that is not working well.

Symptoms:
The following symptoms are associated with aortic valve stenosis, which may indicate the need for a TAVI procedure:

  • Chest pain
  • Shortness of breath 
  • Breathlessness
  • Fatigue
  • Fainting 
  • Dizziness 

The following diagnostic tests may be performed before a TAVI procedure:

  1. Physical examination: The doctor examines the symptoms of the patient. A heart murmur sound (a whooshing sound) heard with a stethoscope may indicate an aortic valve condition. The medical history and family history of the patient are also noted.
  2. Echocardiogram: Sound waves are used to obtain the images of the heart in motion in this type of imaging test. It helps the doctor in identifying a weakened heart muscle and determining the severity of aortic valve stenosis.
  3. Transesophageal echocardiogram: This test involves the use of a flexible tube containing a transducer that is guided down the throat into the esophagus.
  4. Electrocardiogram or ECG: This is a painless test performed to record the electrical activity of the heart by attaching small sensors, known as electrodes, to the chest, arms, and legs region. It helps in detecting heart diseases, abnormal heart rhythms, and enlarged chambers of the heart.
  5. Chest x-ray: It helps the doctor in checking if the heart is enlarged, which is a sign of aortic valve stenosis. The x-ray also shows if there is calcium buildup on the aortic valve and swelling of the aorta.
  6. Stress test: This test helps the doctor in determining whether the symptoms of aortic valve disease occur during physical activity or by use of certain medications.
  7. Cardiac computerized tomography (CT) scan: This is an imaging test done to obtain clear images of the heart. It is used to measure the aorta size and have a closer look at the aortic valve.
  8. Cardiac MRI scan: This imaging test makes use of a strong magnetic field and radio waves to create detailed images of the heart. This test is used to determine the severity of the condition and evaluate the aorta size.
  9. Cardiac catheterization: The doctor threads a thin, flexible tube known as a catheter through a blood vessel in the arm or groin area and guides it to an artery in the heart. Sometimes, a dye may be injected to make the arteries clearer in an x-ray. This test is done to check that the arteries that feed the heart muscles, known as coronary arteries, are not blocked.

 

  • The procedure is either performed under local anesthesia (the area of operation is numbed) or general anesthesia (the patient is put to sleep during the procedure).
  • The doctor inserts a balloon catheter into an artery either in the groin area or underneath the collarbone after making a small incision (cut) in that area.
  • This balloon catheter is then guided into the heart and positioned within the aortic valve opening.
  • Its position is confirmed using an echocardiogram or moving x-ray images.
  • Once its position is confirmed, the doctor will gently inflate the balloon to open up the valve.
  • A new biological tissue valve (made up of pig or cow heart tissue) is then implanted by the doctor using a metal mesh tube which helps in keeping the valve in its place.
  • The new valve will either expand by itself or the doctor expands it using the balloon.
  • The new valve is usually positioned in a way that it pushes aside the damaged aortic valve.
  • The balloon is then deflated and the balloon catheter is removed.

 

The following risks are associated with a TAVI procedure:

  • Bleeding
  • Complications associated with the blood vessels
  • Stroke (a condition of interrupted blood supply to the brain)
  • Kidney disease
  • Heart attack
  • Infection
  • Arrhythmias (irregular heart rhythm)
  • Need for a pacemaker (a device implanted in the heart to correct arrhythmia)
  • Slipping out of the replacement valve
  • Aortic regurgitation (leaking of the aortic valve)
  • Death
  • You will most likely spend the night in the intensive care unit (ICU) for monitoring after the procedure.
  • Your stay in the hospital will depend on several factors, including the severity of the condition. Some people may be able to go home on the next day of the procedure.
  • You may be prescribed blood-thinners, also known as anticoagulants, by the doctor to prevent blood clots.
  • The doctor may also prescribe antibiotics to prevent bacterial valve infections that usually come from bacteria in the mouth.
  • You will be told to maintain excellent dental hygiene and routine dental clean-ups by the dentist to prevent bacterial infections.
  • The doctor will explain how to take care of the incisions and to look for signs of infection.
  • Regular checkups by the doctor and imaging tests are needed after the TAVI procedure to ensure that the new valve is working well.

Visit your doctor immediately if you have any of the following symptoms after the procedure:

  • Dizziness
  • Light-headedness
  • Sudden gain of weight
  • Swelling of the ankles
  • Severe tiredness
  • Symptoms of infection, like fever, redness, increased pain, swelling, drainage at the incision site
  • Chest pain, tightness, or pressure
  • Fainting
  • Shortness of breath

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TAVI

Transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement (TAVR) is a minimally-invasive heart procedure performed to repair a damaged aortic valve.

The aortic valve is one of the four heart valves that is located between the lower-left heart chamber, known as the left ventricle, and the main artery of the heart, known as the aorta.

Aortic valve stenosis is a condition that occurs when the aortic valve of the heart thickens and calcifies (becomes stiff) causing the valve to not open fully and leading to a reduced blood flow to the body.
TAVI procedure helps in the restoration of blood flow and reducing the symptoms of aortic stenosis.

Symptoms

Purpose:

  • TAVI procedure is a minimally-invasive procedure done to treat aortic valve stenosis.
  • TAVI is an alternative to open-heart surgery which is an invasive procedure, and is recommended in the following cases:
  • Severe aortic stenosis leading to various symptoms.
  • Presence of other health disorders, like lung or kidney disease, which makes open-heart valve replacement surgery extremely risky.
  • Presence of a biological tissue aortic valve (an artificial valve made of human or animal tissue) that is not working well.

Symptoms:
The following symptoms are associated with aortic valve stenosis, which may indicate the need for a TAVI procedure:

  • Chest pain
  • Shortness of breath 
  • Breathlessness
  • Fatigue
  • Fainting 
  • Dizziness 

Diagnosis

The following diagnostic tests may be performed before a TAVI procedure:

  1. Physical examination: The doctor examines the symptoms of the patient. A heart murmur sound (a whooshing sound) heard with a stethoscope may indicate an aortic valve condition. The medical history and family history of the patient are also noted.
  2. Echocardiogram: Sound waves are used to obtain the images of the heart in motion in this type of imaging test. It helps the doctor in identifying a weakened heart muscle and determining the severity of aortic valve stenosis.
  3. Transesophageal echocardiogram: This test involves the use of a flexible tube containing a transducer that is guided down the throat into the esophagus.
  4. Electrocardiogram or ECG: This is a painless test performed to record the electrical activity of the heart by attaching small sensors, known as electrodes, to the chest, arms, and legs region. It helps in detecting heart diseases, abnormal heart rhythms, and enlarged chambers of the heart.
  5. Chest x-ray: It helps the doctor in checking if the heart is enlarged, which is a sign of aortic valve stenosis. The x-ray also shows if there is calcium buildup on the aortic valve and swelling of the aorta.
  6. Stress test: This test helps the doctor in determining whether the symptoms of aortic valve disease occur during physical activity or by use of certain medications.
  7. Cardiac computerized tomography (CT) scan: This is an imaging test done to obtain clear images of the heart. It is used to measure the aorta size and have a closer look at the aortic valve.
  8. Cardiac MRI scan: This imaging test makes use of a strong magnetic field and radio waves to create detailed images of the heart. This test is used to determine the severity of the condition and evaluate the aorta size.
  9. Cardiac catheterization: The doctor threads a thin, flexible tube known as a catheter through a blood vessel in the arm or groin area and guides it to an artery in the heart. Sometimes, a dye may be injected to make the arteries clearer in an x-ray. This test is done to check that the arteries that feed the heart muscles, known as coronary arteries, are not blocked.

 

Treatment

  • The procedure is either performed under local anesthesia (the area of operation is numbed) or general anesthesia (the patient is put to sleep during the procedure).
  • The doctor inserts a balloon catheter into an artery either in the groin area or underneath the collarbone after making a small incision (cut) in that area.
  • This balloon catheter is then guided into the heart and positioned within the aortic valve opening.
  • Its position is confirmed using an echocardiogram or moving x-ray images.
  • Once its position is confirmed, the doctor will gently inflate the balloon to open up the valve.
  • A new biological tissue valve (made up of pig or cow heart tissue) is then implanted by the doctor using a metal mesh tube which helps in keeping the valve in its place.
  • The new valve will either expand by itself or the doctor expands it using the balloon.
  • The new valve is usually positioned in a way that it pushes aside the damaged aortic valve.
  • The balloon is then deflated and the balloon catheter is removed.

 

Risks

The following risks are associated with a TAVI procedure:

  • Bleeding
  • Complications associated with the blood vessels
  • Stroke (a condition of interrupted blood supply to the brain)
  • Kidney disease
  • Heart attack
  • Infection
  • Arrhythmias (irregular heart rhythm)
  • Need for a pacemaker (a device implanted in the heart to correct arrhythmia)
  • Slipping out of the replacement valve
  • Aortic regurgitation (leaking of the aortic valve)
  • Death

After Procedure

  • You will most likely spend the night in the intensive care unit (ICU) for monitoring after the procedure.
  • Your stay in the hospital will depend on several factors, including the severity of the condition. Some people may be able to go home on the next day of the procedure.
  • You may be prescribed blood-thinners, also known as anticoagulants, by the doctor to prevent blood clots.
  • The doctor may also prescribe antibiotics to prevent bacterial valve infections that usually come from bacteria in the mouth.
  • You will be told to maintain excellent dental hygiene and routine dental clean-ups by the dentist to prevent bacterial infections.
  • The doctor will explain how to take care of the incisions and to look for signs of infection.
  • Regular checkups by the doctor and imaging tests are needed after the TAVI procedure to ensure that the new valve is working well.

Visit your doctor immediately if you have any of the following symptoms after the procedure:

  • Dizziness
  • Light-headedness
  • Sudden gain of weight
  • Swelling of the ankles
  • Severe tiredness
  • Symptoms of infection, like fever, redness, increased pain, swelling, drainage at the incision site
  • Chest pain, tightness, or pressure
  • Fainting
  • Shortness of breath

FAQ Section

1) What is a TAVI heart procedure?

The aortic valve controls blood flow between the left ventricle and the aorta which is the vessel that delivers oxygen-rich blood to the body. The two main problems that can occur with the aortic valve are it can become hardened and narrowed, or it can leak. The most common problem faced by the elderly is called age-related calcific degeneration in which the gradual buildup of calcium causes the valve to narrow. In patients who are at high risk of complications in open-heart or minimally invasive valve replacement surgery, the aortic valve can be replaced by transcatheter aortic valve implantation (TAVI).

In TAVI, a biological valve made up of big or cow heart tissue is mounted inside a stent which is a circular wire mesh. The stent is then compressed so that it can fit inside a small delivery sheath or tube. The TAVI valve is then delivered to the aortic valve where the stent is expanded, and the biological valve inside begins to work. Unlike valve replacement through surgery, the calcified leaflets of the patient’s diseased aortic valve are not removed, instead, they are pushed to the side on the expansion stent where they help to lock the stent in place.

2) How long does it take to recover from a Tavi operation?

The rate of recovery after a Tavi operation varies from patient to patient, but most people take about 6 to 10 weeks to feel fully recovered.

3) What is the cost of TAVI procedure in India?

The cost of TAVI procedure in India varies across different cities and hospitals.

Cost of TAVI procedure in India
CITY COST
Cost of TAVI procedure in Mumbai    INR 1900000- INR 2500000
Cost of TAVI procedure in Bangalore INR 1870000- INR 2480000
Cost of TAVI procedure in Delhi INR 1870000- INR 2480000
Cost of TAVI procedure in Chennai   INR 1850000- INR 2460000

 

4) What is the difference between Tavr and Tavi?

There is no difference between Tavr and Tavi. Tavr stands for transcatheter aortic valve replacement while Tavi stands for transcatheter aortic valve implantation. They both are the different name of the same procedure.

5) What is the success rate of Tavi?

The researchers found that the procedure had a 95.7 percent success rate in attempted Tavi, with thirty-day mortality rate being as low as 4 percent and stroke rate was noted to be 1.6 percent. After one-year 76 percent of patients completed their follow-up, and at one-year, the mortality rate was 17.5 percent and stroke rate was 3.5 percent.

6) What are the risks of Tavi?

Although TAVI has a high success rate with few surgical complications, like all other medical procedures, it comes with its own risks, and these risks can come in the form of complications that include vascular injuries, bleeding, atrioventricular conduction system injuries, stroke, AKI, and aortic regurgitation. Also, If an incorrect valve size for the patient's anatomy is used, it may lead to heart injury, valve leakage, or dislodgement.

7) How long does a Tavi operation take?

The transcatheter valve implantation (TAVI) procedure takes 45 to 60 minutes, but going into the operating theater, having the procedure performed and leaving the theater takes two to three hours.

8) Is Tavi considered surgery?

Tavi is a less invasive procedure that is designed to replace a diseased aortic valve and is not considered major surgery.

9) What is a TAVI valve made of?

TAVI valve is an artificial valve made of natural animal heart tissue which usually comes from a cow or a pig.

10) How long does a Tavi valve last?

Although mechanical valves are expected to last the life of the patient, the valves made of animal tissue are estimated to last 10 to 15 years or more. Tavi valve is also made of animal tissues, yet currently, there are only preliminary data to show that TAVR valves may last at least five years without showing any signs of early degeneration.

11) What is an aortic valve?

Aortic valve is one of the four heart valves that is located between the left ventricle (lower left heart chamber) and the aorta (the main artery of the heart).

 

12) What is the function of the aortic valve?

The aortic valve helps in the proper unidirectional flow of blood from the heart to the rest of the body. 

 

13) What is aortic valve stenosis?

The narrowing of the valve in the aorta is known as aortic stenosis or aortic valve stenosis. The narrowing prevents the valve from opening fully and causes reduced blood flow to the rest of the body.

 

14) What is the purpose of a TAVI procedure?

TAVI procedure is done for treating aortic valve stenosis and is recommended in the following cases:

  • Severe aortic stenosis leading to several symptoms.
  • Presence of other health diseases, such as lung or kidney disorders, which makes open-heart valve replacement surgery very risky.
  • The presence of a biological tissue aortic valve (an artificial valve made of animal or human tissue) that fails to work well.

 

15) What are the symptoms that indicate the need for a TAVI?

The following symptoms are seen in aortic valve stenosis, and may indicate a need for TAVI procedure:

  • Chest pain
  • Breathlessness
  • Shortness of breath
  • Fainting 
  • Dizziness 
  • Fatigue

16) What is the diagnostic procedure before a TAVI procedure?

The following diagnostic tests may be performed before a TAVI procedure:

  1. Physical examination: The doctor examines the symptoms of the patient. A heart murmur sound (a whooshing sound) heard with a stethoscope may indicate an aortic valve condition. The medical history and family history of the patient are also noted.
  2. Echocardiogram: Sound waves are used to obtain the images of the heart in motion in this type of imaging test. It helps the doctor in identifying a weakened heart muscle and determining the severity of aortic valve stenosis.
  3. Transesophageal echocardiogram: This test involves the use of a flexible tube containing a transducer that is guided down the throat into the esophagus.
  4. Electrocardiogram or ECG: This is a painless test performed to record the electrical activity of the heart by attaching small sensors, known as electrodes, to the chest, arms, and legs region. It helps in detecting heart diseases, abnormal heart rhythms, and enlarged chambers of the heart.
  5. Chest x-ray: It helps the doctor in checking if the heart is enlarged, which is a sign of aortic valve stenosis. The x-ray also shows if there is calcium buildup on the aortic valve and swelling of the aorta.
  6. Stress test: This test helps the doctor in determining whether the symptoms of aortic valve disease occur during physical activity or by the use of certain medications.
  7. Cardiac computerized tomography (CT) scan: This is an imaging test done to obtain clear images of the heart. It is used to measure the aorta size and have a closer look at the aortic valve.
  8. Cardiac MRI scan: This imaging test makes use of a strong magnetic field and radio waves to create detailed images of the heart. This test is used to determine the severity of the condition and evaluate the aorta size.
  9. Cardiac catheterization: The doctor threads a thin, flexible tube known as a catheter through a blood vessel in the arm or groin area and guides it to an artery in the heart. Sometimes, a dye may be injected to make the arteries clearer in an x-ray. This test is done to check that the arteries that feed the heart muscles, known as coronary arteries, are not blocked.

 

17) How to prepare for a TAVI procedure?

The following preparation may be needed for a TAVI procedure:

  • Inform the doctor about the regular medications, supplements, or herbs that you may be taking.
  • Inform the doctor if you have any medical ailments.
  • The doctor should be informed if you have a known sensitivity or allergy to any medications, anesthetic agents, iodine, tape, or latex.
  • The doctor may instruct you to stop taking blood-thinners like aspirin and warfarin, and diabetic medications at least three days before the procedure.
  • Stop smoking as soon as you can.
  • You will be instructed to not eat anything six hours before the procedure.
  • You will be instructed to not drink any clear fluids (drinks through which one can see through, like water and tea two hours before the procedure.
  • You will be asked to remove all your jewelry and wear a hospital gown before the procedure starts.

 

18) What are the post-procedure steps following a TAVI procedure?

The following are the post-procedure steps following a TAVI procedure:

  • You will most likely spend the night in the intensive care unit (ICU) for monitoring after the procedure.
  • Your stay in the hospital will depend on several factors, including the severity of the condition. Some people may be able to go home on the next day of the procedure.
  • You may be prescribed blood-thinners, also known as anticoagulants, by the doctor to prevent blood clots.
  • The doctor may also prescribe antibiotics to prevent bacterial valve infections that usually come from bacteria in the mouth.
  • You will be told to maintain excellent dental hygiene and routine dental clean-ups by the dentist to prevent bacterial infections.
  • The doctor will explain how to take care of the incisions and to look for signs of infection.
  • Regular checkups by the doctor and imaging tests are needed after the TAVI procedure to ensure that the new valve is working well.

Visit your doctor immediately if you have any of the following symptoms after the procedure:

  • Dizziness
  • Light-headedness
  • Sudden gain of weight
  • Swelling of the ankles
  • Severe tiredness
  • Symptoms of infection, like fever, redness, increased pain, swelling, drainage at the incision site
  • Chest pain, tightness, or pressure
  • Fainting
  • Shortness of breath

19) What are the risks of a TAVI procedure?

The following complications may be associated with a TAVI procedure:

  • Bleeding
  • Infection
  • Blood vessel complications
  • Stroke (a condition in which the blood supply to the brain is reduced)
  • Kidney disease
  • Heart attack
  • Arrhythmias (irregular heartbeats)
  • Replacement valve slips out
  • Pacemaker (a cardiac implanted device to correct arrhythmia) requirement
  • Aortic regurgitation (leaking of the aortic valve)
  • Death