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TAVI
An emerging technology that can be used to treat aortic valve disease is TAVI. This stands for Transcatheter Aortic Valve Implantation.
TAVI is not an open surgery. The heart is not stopped with TAVI and the heart and lung machine is not needed. Instead, special wires and catheters are fed thru an artery, usually an artery in the groin, up into the heart. A special valve is then sent up over the wire, placed in position inside the patient's bad aortic valve, and deployed. The new TAVI valve begins to work immediately. The special wires and catheters are then removed.
TAVI is also known as TAVR. In the USA, many people refer to the procedure as TAVR, whereas in Europe, the term TAVI is often preferred.
The patient's original valve is not cut out when TAVI is performed.
TAVI was invented, or at least first used on a human, in 2002. Dr. Cribier performed the procedure in France.
The TAVI technology was first used on patients for whom essentially there were no other options. TAVI has proven so successful that TAVI is now used on patients with less risk.
The FDA has approved TAVI for high risk patients and intermediate risk patients, as well as low risk patients.
TAVI is generally used to treat aortic valve stenosis. Stenosis refers to narrowing. In aortic valve stenosis - which most people shorten to simply aortic stenosis - the valve is stiff and does not open well. This stiffness creates extra work for the heart to generate enough pressure to open the stiff valve and move the blood out and past it.
TAVI can be used for aortic insufficiency - for a leaky aortic valve - but only if the patient already underwent an AVR. If the patient never had heart surgery before and the valve is leaking but not stiff (stenotic), then TAVI is not FDA-approved and most patients will need an AVR to address the problem.
In general, valves only need to be replaced if there is SEVERE stenosis, which is causing the patient to have symptoms, or if the heart is becoming weak.
In general, valves only need to be replaced if there is SEVERE stenosis, which is causing the patient to have symptoms, or if the heart is becoming weak.
The symptoms that usually occur with aortic stenosis are shortness of breath, tiredness, passing out, or chest pain. If you have any of these symptoms, please seek an opinion from your physician.
There are several tests which need to be done prior to TAVI, including a special CT scan and a cardiac catheterization. Dr. Pool and his team will guide you thru which tests you may need, if they have not been done yet.
Once testing is completed, Dr. Pool and his team will decide which artery to access in order to place the TAVI valve. 95% of the time, an artery in the groin is used. If the groin arteries are not suitable, then an artery by the collarbone is preferred next. If that artery is not suitable, then other access points will be considered.
Dr. Pool's team has done several hundred TAVI procedures.
Dr. Pool and his team now teach other doctors how to do the procedure.
Dr. Pool and his team now teach other doctors how to do the procedure.
The procedure with Dr. Pool and his team usually goes like this:
Most patients do not need general anesthetic and thus do not need a breathing tube inserted. The patient is sedated, basically asleep.
The procedure is performed, typically with the valve inserted thru an artery in the groin. The procedure usually takes 45 min to an hour.
The procedure is performed in the hybrid OR, which has all the capabilities of the operating room and all the capabilities of the cath lab.
Most patients do not need to go the ICU.
Most patients go home the next day.
The anesthesia is delivered by a Board-certified cardiac anesthesiologist.
There are two valves approved by the FDA for use in the United States:
TAVI
VALVES
TAVI valves are a special kind of valve, made of tissue and a metal stent.
The Edwards Sapien valve has cow tissue inside a cobalt-chromium stent.
The Medtronic Evolut valve has pig tissue inside a metal alloy (Nitinol) stent.
If a patient is a candidate for TAVI, Dr. Pool and the team will determine which particular TAVI valve is best for that patient.
Since it is a relatively new technology, it is not clear how long a TAVI valve will last, though it is expected that TAVI valves will likely last 12-15 years.
Patients need to be on Plavix for at least 6 months after a TAVI valve is placed.
Though made from cow or pig tissue, TAVI valves are not rejected by the human body. This is because the immunologic proteins are washed off, so the body does not react to it.
TAVI Team
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