Aortic stenosis, the progressive failure of the aortic valve to open fully, is one of the most common types of heart disease in elderly people. 3% of elderlies aged 75 years and above have this condition. As you age, calcium can build up on the valve, making it harder and thicker. As a result, your aortic valve is unable to open properly, forcing the heart to work harder to pump blood through the narrowed valve. This can lead to heart failure. Transcatheter aortic valve implantation (TAVI) is a new minimally invasive surgical technique. It is suitable for high risk elderly patients who cannot undergo open-heart surgery.
Symptoms of aortic stenosis
- Fatigue
- Heart palpitations – sensations of a rapid, fluttering heartbeat
- Feeling faint or dizzy
- Chest pain or tightness of chest – 2-3 times per week
What is TAVI?
TAVI – Transcatheter Aortic Valve Implantation or TAVR – Transcatheter Aortic Valve Replacement is a less invasive procedure compared to conventional open-heart valve surgery. In this procedure, the doctor inserts a catheter in your groin or chest and guide it to your heart. Transcatheter aortic valves are specially designed for this procedure. In order to implant it into the heart, the valve is squeezed inside a 5-8 mm catheter. The catheter is then inserted and guided to the aortic valve opening in your heart where it is implanted over your existing valve. When the valve is implanted, the doctor removes the catheter from your blood vessel.
TAVI Approach
- Transfemoral : groin – the most common approach as the artery is larger
- Transaxillary: through large artery near the shoulder
- Transaortic: through large artery at the right side of the chest
- Transapical: through the incision at the left side of the chest at the apex of the heart
Advantages of TAVI
- Less blood loss
- Faster recovery time – only 2-3 days hospital stay
- Smaller incision
- Reduced complications of general anesthesia as the procedure can be done under local anesthesia
- Only 2 hours surgical time
Patients considered not suitable for TAVI
- Patient with infection
- Patient with bacteremia
- Patient with cardiac embolism
- Patient who have had a stroke and cannot take an anticoagulant
- Patient with coronary heart disease that needs coronary artery bypass surgery
After TAVI
- Patient has to take an anticoagulant for 3 months
- After 3 months, patient will be able to perform normal activities. The patient will no longer have chest pain or shortness of breath.
TAVI procedure requires a fully functional hybrid operating room and highly experienced staffs including cardiac surgeon, interventional cardiologist, anesthesiologist, interventional radiologist, specialized nurse, and cardiac catheterization technician. Bangkok hospital’s hybrid operating room combines state-of-the-art surgical technology with the most cutting-edge imaging capabilities in one location. The operating table can be fully adjusted with 360 degree rotation to achieve optimal positioning. For optimal imaging technique, Flex Move Heart Navigator, provides high-resolution images, allowing surgeons to perform intricate procedures with extreme precision in less time. A major advantage of the hybrid OR is that the combined resources and expertise allows for a more rapid and tailored response to unexpected complications. This can speed up surgical process and improve patient safety.
