AORTIC VALVE IMPLANTATION - TAVI
IN TURKEY
TAVI should be applied primarily to all patients over a certain age who will be fitted with a biological valve, and surgery should be applied to patients who cannot undergo TAVI. In particular, all patients over the age of 60-65 should primarily prefer a biological valve. In these patients, if there is a situation where TAVI cannot be performed technically or anatomically, open surgery should be considered.
WHAT IS AORTIC VALVE IMPLANTATION - TAVI?
Aortic stenosis; It is the narrowing or deterioration of the valve between the left ventricle of the heart, which pumps blood to the body, and the aortic main artery. When aortic stenosis progresses, the left ventricle of the heart is exposed to high pressure and there is a decrease in the amount of blood pumped to the whole body. As a result of aortic stenosis, exposure of the left heart to high pressure and the decrease in blood pumped to the body do not disturb the patient to a certain extent. However, with a significant reduction in the aortic valve; Shortness of breath with exertion, chest pain accompanied by shortness of breath, and, in later cases, fainting complaints occur. In the later stages of aortic stenosis, the patient also has a risk of sudden death. In this regard, in cases of aortic stenosis, patients with surgical problems being able to be treated with TAVI method is an important development. TAVI is an application in which people with aortic valve disease who are unsuitable for surgery due to various reasons are treated with interventional methods.
TAVI is the process of widening the narrowed valve area that reaches the heart through the groin in the angio laboratory, without opening the chest and without stopping the heart. TAVI, which is a method that is generally applied in patients over 80 years of age and in whom open surgery cannot be performed, is performed in cases of aortic stenosis.
IN WHICH SITUATIONS IS AORTIC HEART VALVE REPLACEMENT PERFORMED?
The aortic valve, where aortic stenosis occurs, is the valve located at the mouth of the main vessel that comes directly from the heart. With the advancing age, calcification can be seen in the aortic valve and the valve cannot perform its functions in a healthy way and has difficulty in opening and closing. Which patients should be preferred;
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Advanced age,
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People with chronic health problems as well as heart disease,
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Persons and situations where general anesthesia is inconvenient
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In people whose general health condition is not suitable for surgery
Aortic valve stenosis, which occurs due to advanced age, can turn into a process in which recovery and return to normal life are extremely difficult for patients after open heart surgery, where the recovery process has certain difficulties for each patient. In advanced-aged aortic valve patients, the possibility of lung infection after open heart surgery increases and the chances of recovery are very low. Since the chance of open surgery is lower in older patients than in younger patients, valve repair or replacement is performed in these patients through interventional methods.
HOW IS TAVI PERFORMED?
The TAVI procedure is performed in a method that combines surgery and interventional facilities. The procedure is performed in 2 different ways: In the groin: As in angiography applications, the aortic valve is advanced from the groin to the heart with the help of a catheter, and the stent mechanism is opened and placed there. This method is not suitable if there is a stenosis or obstruction in the veins in the groin area or in the abdomen to be used to reach the heart. With a Tiny Incision: In this technique, a small incision of approximately 3-4 cm is made on the left chest wall to reach the end of the heart, and the valve is placed with a catheter advanced to the heart from there.
In both methods, there is no need to stop the heart and open surgery. The procedure can be performed under local anesthesia without putting the patient to sleep. Postoperative hospital stay is very short, ranging from 1 to 4 days. Patients are mobilized very quickly and can return to their normal lives in a period of 1 week.
ADVANTAGES OF TAVI
The most important advantage is that the patient's chest does not open and his heart is not stopped. In addition, the patient does not receive general anesthesia. When we look at the complications of surgery, especially when compared to surgery, kidney failure is less in these studies. Some rhythm disorders are also less in this process. Processing time is shorter. Also, the length of stay in the intensive care unit is less. The patient easily returns to his normal life. The durability of the biocap is also an important advantage. Studies of about 7-8 years were observed. According to these studies, there is no doubt that it is durable. However, it will be possible to say more clearly when the work over 10 years is completed. In addition, a new cover can be inserted into this cover with a similar procedure.
WHAT ARE THE RISKS OF TAVI PROCEDURE?
The risk of death and disability in this procedure is higher than other angiographic diagnoses and treatments used in cardiology. However, it should be kept in mind that the TAVI method is performed in patients who cannot undergo surgery or who have a very high risk of surgery, and the existing disease does not have a chance to be treated otherwise. The risk of death in the TAVI procedure and in the following 30 days is 1-5%. Again, the risk of minor or major stroke within 1 month after the procedure is 1-2%. Other than death and stroke, the risks are largely treatable.
FREQUENTLY ASKED QUESTIONS
What should be considered in terms of drug use after the operation?
These are biological valves; that is, they are valves obtained from a bovine or pig pericardium. Therefore, they are compatible with the body. For this, drugs that dilute the blood seriously are not needed. But mild blood thinners are used for a while. It is taken double for about 6 months. After 6 months, a drug such as baby aspirin is used for life.
What kind of anesthesia is used in TAVI? How long does the procedure take?
TAVI has been around the world for 10 years. General anesthesia was used in the first years. Afterwards, it was started to be performed with local anesthesia and mild sedation. The process takes an hour on average if all goes well. The length of stay in the hospital is shaped according to the situation of each individual. If there is an inconvenient situation in terms of the general health of the patient, the patient can be kept in the intensive care unit for a few days. However, if everything goes well, he is kept for observation only for one day in the intensive care unit, one day in the service and discharged the next day.
Is TAVI a painful procedure?
The patient does not feel any pain during and after the treatment.
Who can be a candidate for TAVI?
Aortic valve disease is a disease of advanced age. TAVI procedure can be applied especially to patients who are older, have additional health problems besides heart disease, are inconvenient to receive general anesthesia and whose general health condition is not suitable for surgery. However, with the increase in the experience of the procedure and successful results, it has become applicable in patients with medium or low risk of surgery.
What is aortic stenosis?
The aortic valve is the valve at the mouth of the main artery that leaves the heart. With age, calcification can be seen on this cover and the cover cannot be opened and closed well. Aortic valve stenosis is usually a disease of advanced age.
What are the risks that may arise after the operation?
Various complications may occur during the procedure and in the 30-day period after the procedure. Rupture and associated bleeding in the operated vessels are among the common complications and require surgical intervention and blood transfusion. In addition, problems such as damage to the heart or vascular tissue and edema around the heart are among the serious complications.
As a result of the studies, the risk of stroke after the aortic valve placement through the catheter is 4%, the risk of significant leakage in the inserted valve, that is, the risk of developing insufficiency, is 2-12%, the need for a permanent pacemaker is 2-16%, the kidney failure problem requiring dialysis is seen in the one-year period after the procedure. The risk is around 5%.