What is TAVI?
Transcatheter aortic valve implantation, often known as TAVI, is a minimally invasive surgical procedure used to insert new aortic valves into the heart to replace old, narrowed ones. Transcatheter aortic valve replacement, in which the replacement valve is inserted inside the unhealthy valve (TAVR).
The main purpose of this operation is to cure severe aortic stenosis (AS). The aortic valve narrows dramatically in this situation, making it difficult for blood to flow through it and to the rest of the body. It can result in heart failure or sudden cardiac death and cause chest pain, exhaustion, shortness of breath, etc.
The procedure of TAVI
TAVI is a simple operation that is quite similar to inserting a stent. The aortic valve can be accessed using one of two techniques. A tiny incision in the chest can be used to reach big vessels in the chest or the left ventricle of the heart (transapical approach), or a catheter may be sent up the femoral artery in the leg (transfemoral approach). The constriction is relieved once the catheter containing the new valve has reached the constricted aortic valve and a balloon on the catheter’s tip has been inflated.
What is SAVR?
The other option for TAVI is open surgery, which involves making a sternotomy to access the chest cavity and operate on the heart directly. Surgical Aortic Valve Replacement is what this is known as (SAVR). TAVI was previously exclusively performed on individuals who were considered to be at intermediate or high risk for undergoing surgery. The preferred course of treatment for patients with a low risk of postoperative complications was SAVR.
The TAVI superiority
TAVI is still a better choice than SAVR in low-risk patients, according to two recent studies: the PARTNER 3 trial and the Evolut Low-Risk trial. These trials’ findings demonstrate that TAVI is a superior treatment option, even for low-risk surgical patients for whom SAVR has traditionally been the recommended method of treating severe aortic stenosis. The results of SAVR are quite good for the low-risk population. Even so, SAVR is major surgery with higher expenses than the relatively rapid and less complex TAVI, and TAVI had fewer deaths, strokes, and readmissions.
The future
We are certain that TAVI will continue to advance and that it is already a very safe and successful treatment. However, it would be naive to think that improving methods and tools would result in the complete elimination of complications. There will still be a small risk associated with access site and device landing zone issues, especially in older patients who are at higher risk. For younger patients and those with infective endocarditis, surgical aortic valve replacement will continue to be the standard treatment.
Conclusion
Hopefully, the following phrase could be used as the opening of stories on TAVI in near future: Regardless of symptoms or operating risk, TAVI has emerged as the first-line treatment for patients with isolated moderate to severe native aortic stenosis or aortic regurgitation, as well as deteriorated transcatheter or surgical bio prostheses.
References
- What is TAVR? (TAVI) | American Heart Association. Accessed June 24, 2022. https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/understanding-your-heart-valve-treatment-options/what-is-tavr
- Tang GHL, Verma S, Bhatt DL. Transcatheter Aortic Valve Replacement in Low-Risk Patients: A New Era in the Treatment of Aortic Stenosis. Circulation. 2019;140(10):801-803. doi:10.1161/CIRCULATIONAHA.119.041111
