Transcatheter aortic valve implantation – TAVI

Much has been said and written about the importance of the heart, and the importance of its proper function. One of the most common problems connected proper heart function is a defective function of the aortic valve – the valve that connects the left ventricle to the aorta, serving as the opening of the heart.

This valve can be damaged as the result of calcification (accumulation of various deposits), which could cause heart failure and severe symptoms and even be life-threatening.

In the past, the only way to treat such a problem was by open-heart surgery, during which the valve was ‘repaired’ or replaced with an artificial valve. Today, this can be done in a much simpler procedure, which assures much easier recovery: TAVI – Trans-catheter Aortic Valve Implantation.

This is a real breakthrough in the field: instead of completely opening the chest, the entire valve can be replaced in a procedure that merely consists of making a tiny opening in the skin, through which a catheter is passed, carrying the new, artificial valve. This procedure has already been in use for some time, internationally and in Israel, and its success rate is very high.

General information about catheterization of the valve

Valve implantation by the TAVI method can be performed via the femoral artery (in the groin), via the subclavian artery (in the region of the shoulder) or via the heart apex, between two ribs. As is the case in any catheterization, the procedure is performed using a long catheter that is carefully passed via the chosen artery through to the valve’s location. In a rapid procedure, the artificial valve is ‘installed’ in place of the original aortic valve, and the patient can thus feel a rapid improvement in his condition after the procedure.

Valve implantation by the TAVI method can be done under general anesthesia, but it can be done under local anesthesia only and under sedation. This is a procedure that transforms one of the most complex procedures into a relatively easy and rapid procedure, without compromising the chance for success and the level of effectiveness, as compared to open-heart surgery.

Preparation for TAVI

A few days before the percutaneous coronary intervention, you will undergo diagnostic cardiac catheterization, during which the medical team will closely evaluate the condition of your valve and the condition of the entire heart. You will also be asked to undergo a blood test for blood count, coagulation function and more. On the day of the procedure, you will be required to fast for a few hours, even if the procedure is done under local anesthesia combined with sedation.

The course of valve replacement

After the required preparations and the decision as to the route through which the catheterization will be performed – via the femoral artery, the artery in the region of the shoulder or heart apex – the procedure will begin: the artificial valve will be fitted onto the catheter, and it will be passed via the artery to the heart. The physician will lead the catheter through to a point at which the artificial valve is actually within the existing valve – and then the new valve will open, detach from the catheter and attach to the damaged valve.

The artificial valve presses the valve to the walls and remains in place in its stead, thus fully re-opening the blocked passage, significantly improving heart function and effecting rapid disappearance of symptoms, or at least significantly reducing their severity.

The catheterization usually takes about an hour. When it is completed, you will stay for observation and rest for about two or three days. If the catheterization is performed via an artery in the top half of your body, you will be able to get out of bed and sit already on the day after the catheterization, but if the catheterization is performed via the groin, the wait until getting up will be slightly longer.
In the initial weeks after the catheterization, you will be asked, naturally, to avoid any strenuous activity, in order to enable your heart and body to recover properly.

Side effects after catheterization of the valve

Compared to open-heart surgery, the side effects after valve implantation using a catheter are few, and there are significantly fewer complications. However, there are side effects and there are risks, of course, that it does involve: rupture of the artery through which the catheterization is performed (which can be repaired at the time of the procedure), bleeding from the region where the catheter is introduced, disturbances in heart rhythm necessitating the deployment of a pacemaker, and even stroke. It is important to note that such complications are considered today to be rare, especially in view of the extensive experience accumulated over the years.