This minimally invasive procedure uses an artificial heart valve.
The aortic valve controls blood flow from the left ventricle of your heart to the rest of your body. The valve can become scarred and stiff and not open correctly. This condition is called aortic stenosis. This means the left ventricle of the heart has to work harder to push the blood through the valve. Your heart may have to work too hard to pump blood through this small valve opening to the rest of your body.
In some cases, this extra work will make the muscle of the ventricle thicken. In time, the extra work can tire the heart and cause the heart muscle to weaken. This may lead to increasing heart failure.
Transcatheter aortic valve implantation (TAVI) is also called transcatheter aortic valve replacement (TAVR). This is a procedure that replaces a diseased aortic valve with a man-made valve. This implantation procedure is sometimes recommended as an alternative to open heart surgery. The old heart valve is not removed but acts like an anchor for a new heart valve. This procedure is done through small cuts (incisions) using a long, thin tube (catheter), X-rays and ultrasound.
During the procedure, your doctor inserts a catheter through a blood vessel in your leg to deliver and implant the artificial valve into your heart. Sometimes, the catheter is placed through a small incision in your chest underneath the collarbone. Or it is put through an incision between the ribs. The new valve helps improve blood flow from your heart to the rest of your body.
When is transcatheter aortic valve replacement needed?
You may need transcatheter aortic valve implantation if you have progressive heart failure from aortic stenosis, but you aren’t a good candidate for traditional open-heart aortic valve replacement surgery. (That older, open-chest type of surgery is known as surgical aortic valve replacement, or SAVR).
However, transcatheter aortic valve implantation is now also recommended for patients considered to be low risk.
Conditions that would make open-heart surgery dangerous for you include:
- Advanced age
- Weaker heart
- Past heart surgery
- History of stroke
- COPD (chronic obstructive lung disease)
- Kidney disease
- Diabetes
- Past radiation treatment to your chest
- Large calcium deposits in the blood vessel that carries blood away from your heart (ascending aorta), called porcelain aorta
- Being frail or having a physical disability that would make recovery from an open-heart surgery challenging
At Vanderbilt University Medical Center, a team of specialists works with each patient to create a customized plan for treatment. Part of the care the team provides involves assessing each patient to determine which type of procedure – transcatheter implantation, or open-heart surgery – is best for their circumstances.
How to get ready for a transcatheter aortic valve replacement?
Before the procedure, your heart valve team will evaluate your overall health. This may include X-rays, CT scans, blood tests and other tests to check the health of your lungs and heart. Your medical team will also give you an echocardiogram to evaluate your aortic valve. This test uses sound waves to create images of your heart. Your medical team may also do a cardiac catheterization to evaluate your heart.
What happens during this procedure?
The methods your surgeon uses will depending on your condition and the doctor’s practices. Talk with your provider about what to expect. Generally, a TAVI procedure follows this process:
- The surgeon will place a catheter into your femoral artery and thread it to your heart and through your aorta, to reach your aortic valve.
- The surgeon may also place other catheters in your heart to take measurements and X-ray pictures during the procedure.
- The surgeon will guide your replacement valve, inside an expandable balloon, up the femoral artery catheter and through your old aortic valve.
- Once the balloon is properly positioned, the surgeon will expand it and implant the new valve to replace the old one.
- The surgeon will take measurements and images to make sure your new valve works properly, before removing the catheters.
Vanderbilt University Medical Center is a leader in treating heart valve disease with the newest transcatheter techniques. Vanderbilt’s team includes general cardiologists, interventional cardiologists and cardiac surgeons, all with advanced training and expertise in structural heart and valve disease. They treat patients with diseases of the aortic, mitral or tricuspid valve, from the routine to the complex.
