What is TAVI?
The acronym TAVI derives from the English Transcatheter Aortic Valve Implantation and is currently also used in our country to indicate the procedure of implanting an aortic valve prosthesis through an artery in our body.
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Who can undergo this type of procedure?
TAVI is reserved for patients suffering from aortic valve stenosis, a condition in which the aortic valve, one of the heart’s valves, has narrowed. This condition is an obstacle to the normal passage of blood from the left ventricle to the aorta, and from there to the whole body. Patients suffering from this condition are generally > 65 years of age. The disease manifests itself through 3 possible symptoms: dyspnea (shortness of breath), angina (chest pain) and syncope (fainting with loss of consciousness). Diagnosis is based on the detection of a few typical signs during a visit to a cardiologist, and on the echocardiogram, which estimates the severity of stenosis through a series of measurements taken at the valve. If symptoms are present, i.e. if a patient with aortic stenosis suffers from dyspnea, angina pectoris or syncope, the probability of death becomes very high. There is no medication that can reverse or prevent the worsening of this disease. The only effective treatment is to replace the non-functioning valve with a prosthesis, i.e. an artificial valve that performs the same function as the natural one.
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Who performs the procedure?
TAVI is a procedure carried out by interventional cardiologists, i.e. doctors specializing in cardiology in Turkey, who perform minimally invasive procedures such as coronary angioplasty. For this type of procedure, cardiologists work in collaboration with cardiac surgeons who, however, handle much more invasive heart operations (such as coronary bypass surgery). Working as a group is important for identifying patients suitable for this type of operation, and for resolving any complications that may arise.
What does the procedure involve?
In the vast majority of cases, TAVI is performed via the femoral artery, or by inserting a small tube (introducer) in the groin, through which all the materials needed to guide the prosthesis to the heart are passed. The patient may receive light sedation and local anesthesia at the access site. General anesthesia is generally not required.
The equipment needed to implant the prosthesis includes guidewires, catheters (small plastic tubes) and balloons (which can be used to dilate the valve before implanting the prosthesis, or to dilate the prosthesis after implantation, if this is not the case). works perfectly). The prostheses currently used are biological (made from portions of animal heart tissue) and of 3 main types: balloon-expandable (i.e. mounted on a balloon that determines implantation once inflated), auto-extensible (released with a controlled opening mechanism) or mechanically. released . The type of prosthesis chosen depends on the patient’s anatomical characteristics, i.e. the morphology of the valve and the aorta.
The procedure always requires a temporary pacemaker, i.e. a catheter that artificially stimulates the heart at a certain frequency. The pacemaker has two main functions: it is required for implanting prostheses that expand with the balloon, or in all cases where it is necessary to expand the valve with a balloon, and it also serves as a safety device in the event of major arrhythmias during the procedure.
Once the prosthesis has been implanted, a series of checks are carried out by administering a contrast medium and, if necessary, performing an echocardiography. The procedure concludes with removal of the implant material and closure of the access port, usually by means of stitches located directly on the artery.
How long does the procedure take?
TAVI « Transcatheter Aortic Valve Implantation in Turkey » currently takes an average of 30 to 40 minutes (excluding complications, of course). The longest phase is the one preceding the procedure, i.e. preparation of the access and placement of the temporary pacemaker. Modern systems in the best clinics in Turkey enable installation in a relatively short time.
What is the risk of complications?
According to the most recent estimates, the percentage of complications associated with TAVI is less than 1% if we consider the most serious events resulting in death or the need for urgent open-heart surgery. In studies carried out to date, the percentage of patients who die 30 days after surgery is 2-3%; the probability of stroke is even lower. The most frequent complications are bleeding at the access point (hematoma, rupture of the artery) and the occurrence of certain cardiac rhythm disorders, which in some cases may necessitate the implantation of a permanent pacemaker.
