Transcatheter aortic valve implantation (TAVI), also known as transcatheter aortic valve replacement (TAVR), is a minimally invasive procedure designed to treat severe aortic valve stenosis. During the procedure, a new valve is delivered to the heart through a catheter inserted via an artery, most commonly the femoral artery. This technique is an alternative to conventional open-heart surgery and is particularly beneficial for patients at high surgical risk.
When is TAVI performed?
TAVI is indicated for patients with severe aortic valve stenosis, a condition in which the valve opening is narrowed and does not allow blood to flow freely from the left ventricle into the aorta. This leads to increased cardiac workload and reduced systemic perfusion.
Main indications include:
- Severe aortic valve stenosis: symptoms include shortness of breath, chest pain (angina), dizziness, and syncope.
- High risk of open-heart surgery: elderly patients or those with significant comorbidities such as chronic lung disease, renal impairment, or heart failure.
- Ineligibility for conventional surgery: contraindications to open surgical valve replacement due to the patient’s clinical condition.
Advantages of TAVI
- Minimally invasive approach: no need for open-heart surgery or sternotomy.
- Short recovery period: patients usually return to normal daily activities more rapidly.
- Suitable for elderly patients: recommended for individuals with high surgical risk.
- Improved quality of life: rapid relief of symptoms associated with aortic stenosis.
How is the procedure performed?
Pre-procedural assessment
The patient undergoes a comprehensive evaluation, including:
- Blood tests and electrocardiography.
- Angiography to assess vascular access and patency.
- CT or MRI to evaluate the anatomy of the aorta and peripheral arteries.
- Echocardiography to assess valve morphology and function.
- Antithrombotic medications are prescribed prior to the procedure.
The TAVI procedure
- Anesthesia: the procedure is performed under local anesthesia with mild sedation or, in selected cases, general anesthesia.
- Vascular access: the transfemoral approach is most commonly used, although alternative routes may be chosen, such as transapical (via the apex of the heart) or transsubclavian access.
- Catheter delivery: the prosthetic valve, mounted on a catheter in a collapsed state, is advanced to the site of the native aortic valve.
- Valve deployment: the new valve is expanded within the diseased native valve, either by balloon inflation (balloon-expandable valve) or by self-expansion.
- Functional assessment: valve position and function are verified using echocardiography and angiography.
Completion of the procedure: the catheter is withdrawn and the vascular access site is closed.
Post-procedural period
- In-hospital monitoring: the patient is observed for 1–3 days to ensure hemodynamic stability.
- Medication therapy: antithrombotic treatment is prescribed to prevent thromboembolic complications.
- Rehabilitation: gradual resumption of physical activity is recommended.
- Diet and lifestyle: adherence to a healthy diet, smoking cessation, and blood pressure control are advised.
Outcomes of the procedure
- Clinical effectiveness: TAVI demonstrates high procedural success rates and significant symptom improvement in patients with severe aortic stenosis.
- Valve durability: implanted valves typically function for 10–15 years, after which reintervention may be required.
- Improved quality of life: most patients report enhanced exercise tolerance and reduced symptoms.
- Need for regular follow-up: routine clinical assessments and echocardiography are essential to monitor valve performance.
Transcatheter aortic valve implantation (TAVI) in Belarus is a safe and effective treatment option for patients with severe aortic valve stenosis, particularly those at high surgical risk. Owing to its minimally invasive nature, the procedure allows rapid recovery and significant improvement in quality of life. Regular medical follow-up and adherence to physician recommendations help prolong valve durability and maintain optimal health outcomes.
