Transcatheter Aortic Valve Replacement

 

Dr-Brijeshwar-200x300-team-member

Brijeshwar Maini, MD, FACC
National Medical Director of Structural Heart and Transcatheter Therapies.

 

This revolutionary new heart procedure is an advanced minimally invasive treatment option for patients suffering from severe aortic stenosis. For some patients, traditional treatments such as open-heart surgery may not be an option.

However, there is new hope for patients with the TAVR procedure. TAVR has already helped thousands of patients with aortic stenosis return to the things they enjoy in life.

This minimally invasive surgical procedure repairs the valve without removing the old, damaged valve. Instead, it wedges a replacement valve into the aortic valve’s place. The surgery may be called a transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI).

Somewhat similar to a stent placed in an artery, the TAVR approach delivers a fully collapsible replacement valve to the valve site through a catheter. Once the new valve is expanded, it pushes the old valve leaflets out of the way and the tissue in the replacement valve takes over the job of regulating blood flow.

How is TAVR or TAVI different from the standard valve replacement?
This procedure is fairly new and is FDA approved for people with symptomatic aortic stenosis who are considered a high-risk patient for standard valve replacement surgery. The differences in the two procedures are significant.

What is involved in a TAVR procedure?
Usually valve replacement requires an open-heart procedure with a “sternotomy,” in which the chest is surgically separated (open) for the procedure. The TAVR procedure can be done through very small openings that leave all the chest bones in place.

TAVR provides a beneficial treatment option to people who may not be candidates for traditional surgical intervention. A patient's experience with a TAVR procedure may be comparable to a balloon treatment or even an angiogramin in terms of down time and recovery, and may require a shorter hospital stay (average 3-5 days).

The TAVR procedure is performed using one of two different approaches, allowing the cardiologist or surgeon to choose which one provides the best and safest way to access the valve:

  • Entering through the femoral artery (large artery in the groin), called the transfemoral approach, which does not require a surgical incision in the chest
  • Using a minimally invasive surgical approach with a small incision in the chest and entering through a large artery in the chest or through the tip of the left ventricle (the apex), which is known as the transapical approach.

More Information

Your Heart and Inflammation

When you cut your finger or turn your ankle, it swells, turns red and hurts. This can be sign of inflammation, which is your body’s response – or fight against – infection, injury or an irritant. However, inflammation isn’t always good for your body. The immune system can fight against the body’s own cells by mistake, leading to serious health problems, including causing damage to your heart.

And, although there is no specific proof that inflammation can cause cardiovascular disease, inflammation is common among heart disease and stroke patients. According to the American Heart Association, the body appears to perceive the build-up of fatty, cholesterol-rich plaque in blood vessels as abnormal or foreign and tries to ‘wall off’ the plaque from flowing blood. This could cause a blood clot formation, leading to a heart attack or stroke.

Three Main Types of Heart Inflammation

  • Endocarditis – inflammation of the inner lining of the heart’s chambers and valves.
  • Myocarditis – inflammation of the heart muscle.
  • Pericarditis – inflammation of the tissue that forms a sac around the heart.

Causes of Heart Inflammation

Many times the causes of heart inflammation aren’t known. When the cause is known, it is usually due to a viral, bacterial or fungal infection. Additionally, some autoimmune diseases can cause the immune system to mistakenly turn against the heart, resulting in inflammation and damage.

Signs and Symptoms

The signs and symptoms depend on which type of heart inflammation you have and can happen suddenly or progress slowly with severe symptoms or almost no symptoms at all. Symptoms can vary from fever and chills, abdominal pain and night sweats to chest pain, fast heartbeat and fever. If you have a reason to think you are at risk for heart inflammation, please talk with your doctor.

Diagnosis and Treatment

Your doctor will diagnose heart inflammation based on your medical history, a physical exam and diagnostic tests and imaging studies, such as an electrocardiogram (ECG or EKG) to look for changes in your heart’s electrical activity or cardiac magnetic resonance imaging (MRI) to detect inflammation and swelling. Often with pericarditis, the cause of the inflammation may remain unknown.

If you are diagnosed with heart inflammation, your doctor may prescribe medicine to treat the disease, or consider surgery to manage the damage or remove excess fluid. In mild cases, the inflammation may go away on its own.

Sources:
National Center for Biotechnology Information/National Library of Medicine/National Institutes of Health
American Heart Association
Healthline

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