No need to open the chest.
Transcatheter Aortic Valve Replacement / Transcatheter Aortic Valve Implantation (TAVR / TAVI)
What is Aortic stenosis
Aortic stenosis involves narrowing of the aortic valve which obstructs the blood flow from the heart to the body.
Symptoms of Aortic stenosis
Chest pain on exertion.
Breathlessness on exertion.
Dizziness/Blackout on exertion.
Diagnosis of Aortic stenosis
Clinical Examination.
ECG.
Two dimensional echocardiogram.
Progress of the disease
When it becomes severe it causes symptoms and reduces the life span of the patient.
Prognosis of the disease
Poor if untreated, 5 years survival rate of less than 10 %.
If patient has symptoms of heart failure , then median survival is 2 years.
Treatment options for Aortic stenosis
TAVR / TAVI (Transcatheter aortic valve replacement / Transcatheter aortic valve implantation)
SAVR (Surgical aortic valve replacement)
Types of TAVR valves
Balloon expandable (Sapien 3, Myval)
Self expandable (Evolut R, Accurate Neo, Portico, Lotus edge)
Advantages of TAVR over surgical aortic valve replacement (SAVR)
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Done through groin (Common femoral artery) in most of the cases.
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No need for cardiopulmonary bypass.
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Can be done under local anaesthesia.
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Early mobilisation.
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Discharge after 48 hours in majority of cases.
Who benefits most from TAVR
Patients with symptomatic severe degenerative tricuspid aortic valve stenosis need to be evaluated by a multidisciplinary team of specialist doctors. It involves assessment of other co morbidities such as chronic kidney disease, chronic lung disease, malignancies, autoimmune diseases, previous cardiac surgeries etc which increase the procedural risk. It also involves frailty assessment. CT scan of heart and peripheral vessels and coronary angiogram are a pre-requisite. All patients with symptomatic severe degenerative tricuspid aortic valve stenosis and patients with symptomatic dysfunctional biological aortic valves (surgical / transcatheter) benefit most from TAVR.